Provider Demographics
NPI:1275392631
Name:MANG, GARRETT ROY (PA-C)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:ROY
Last Name:MANG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 HOPI DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4954
Mailing Address - Country:US
Mailing Address - Phone:224-321-8201
Mailing Address - Fax:
Practice Address - Street 1:2790 MOSSIDE BLVD STE G110
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2766
Practice Address - Country:US
Practice Address - Phone:412-372-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065226363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical