Provider Demographics
NPI:1346241403
Name:MANGANO, LINN M (MD)
Entity Type:Individual
Prefix:
First Name:LINN
Middle Name:M
Last Name:MANGANO
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 1:3333 BURNET AVENUE
Mailing Address - Street 2:ML 4008
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4751
Mailing Address - Fax:513-636-7911
Practice Address - Street 1:3333 BURNET AVENUE
Practice Address - Street 2:ML 4008
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4751
Practice Address - Fax:513-636-7911
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP004207W00000X
OH35.067259207W00000X
MO2011016767207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0095982000Medicaid
WVP00354867OtherRAILROAD MEDICARE
IN200099910Medicaid
WV0095982000Medicaid
INF87222Medicare UPIN
IN200099910Medicaid
WVMA6034871Medicare PIN