Provider Demographics
NPI:1447216924
Name:MANGANO, ANTHONY R (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:R
Last Name:MANGANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14231-1368
Mailing Address - Country:US
Mailing Address - Phone:716-859-2954
Mailing Address - Fax:716-859-2962
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-859-2954
Practice Address - Fax:716-859-2962
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2261732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1611616OtherINDEPENDENT HEALTH
P00029523OtherRR MEDICARE
000527299001OtherBLUE SHIELD WNY
000527299005OtherBLUE SHIELD WNY
P00131609OtherRR MEDICARE
197608FFOtherPREFERRED CARE
NY2261733WOtherWORKERS COMPENSATION
P020226173OtherBLUE SHIED ROCHESTER
4105275OtherGHI
00026269103OtherUNIVERA
0140611OtherGHI
P010226172OtherBLUE CHOICE
00026269101OtherUNIVERA
NY02389215Medicaid
040426003192OtherFIDELIS
197608FFOtherPREFERRED CARE
P00131609OtherRR MEDICARE
P010226172OtherBLUE CHOICE
NYH82526Medicare UPIN