Provider Demographics
NPI:1225010010
Name:MANGINELLI, STEPHANIE C (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:C
Last Name:MANGINELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:NICOLE
Other - Last Name:CARTWRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:303 MED TECH PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2364
Mailing Address - Country:US
Mailing Address - Phone:423-282-8070
Mailing Address - Fax:423-282-8550
Practice Address - Street 1:303 MED TECH PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2364
Practice Address - Country:US
Practice Address - Phone:423-282-8070
Practice Address - Fax:423-282-8550
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000025987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3122084OtherBLUE CROSS BLUE SHEILD
TN3830484Medicaid
TN3830487Medicaid
TN5470176OtherAETNA
TN3830484Medicaid
TN3830487Medicaid