Provider Demographics
NPI:1891789129
Name:MANGANO, JOHN (RPH DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MANGANO
Suffix:
Gender:M
Credentials:RPH DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7348 HIOLA RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1413
Mailing Address - Country:US
Mailing Address - Phone:215-482-1122
Mailing Address - Fax:215-482-1122
Practice Address - Street 1:2 E VALLEY CREEK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-7147
Practice Address - Country:US
Practice Address - Phone:610-279-9320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003006 L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist