Provider Demographics
NPI:1407849300
Name:MANGAN, SHARON A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:A
Last Name:MANGAN
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:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:517 MOYE BLVD FL 2
Practice Address - Street 2:ECU PHYSICIANS PEDIATRICS
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2849
Practice Address - Country:US
Practice Address - Phone:252-744-3538
Practice Address - Fax:252-744-0392
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601392208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8953841Medicaid
NC53841OtherBCBS NC
NC370015134OtherRAILROAD MEDICARE
NC8953841Medicaid
NC2230737Medicare PIN