Provider Demographics
NPI:1568894871
Name:MANGO-MD
Entity Type:Organization
Organization Name:MANGO-MD
Other - Org Name:MANGO-RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-895-5977
Mailing Address - Street 1:501 HYDE PARK
Mailing Address - Street 2:SUITE 503 - SECOND FLOOR
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18902-6606
Mailing Address - Country:US
Mailing Address - Phone:267-895-5977
Mailing Address - Fax:
Practice Address - Street 1:501 HYDE PARK
Practice Address - Street 2:SUITE 503 - SECOND FLOOR
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18902-6606
Practice Address - Country:US
Practice Address - Phone:267-895-5977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1568894871Medicare Oscar/Certification