Provider Demographics
NPI:1619937927
Name:MANGINO, CAROL A (NPP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:MANGINO
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1613
Mailing Address - Country:US
Mailing Address - Phone:585-344-3190
Mailing Address - Fax:585-344-3235
Practice Address - Street 1:203 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1613
Practice Address - Country:US
Practice Address - Phone:585-344-3190
Practice Address - Fax:585-344-3235
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400776-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02502418Medicaid
NY000590237004OtherBLUE CROSS WNY
NY00026411401OtherUNIVERA
NY117633EUOtherPREFERRED CARE
NY000590237004OtherBLUE CROSS WNY
NY02502418Medicaid