Provider Demographics
NPI:1245238260
Name:MANGION, JUDY R (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:R
Last Name:MANGION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:857-307-1960
Mailing Address - Fax:857-307-1944
Practice Address - Street 1:75 FRANCIS STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:857-307-1960
Practice Address - Fax:857-307-1944
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035126207RC0000X
MA77533207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG52691Medicare UPIN
CT060001543Medicare ID - Type Unspecified