Provider Demographics
NPI:1497460737
Name:MANGANO, NICHOLAS PHILIP III
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:PHILIP
Last Name:MANGANO
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 BRIERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2911
Mailing Address - Country:US
Mailing Address - Phone:161-071-6550
Mailing Address - Fax:
Practice Address - Street 1:1526 BRIERWOOD RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2911
Practice Address - Country:US
Practice Address - Phone:610-716-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program