Provider Demographics
NPI:1942254149
Name:MAGNONE, MARIO (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:MAGNONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-1276
Mailing Address - Country:US
Mailing Address - Phone:251-990-1922
Mailing Address - Fax:
Practice Address - Street 1:750 MORPHY AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1812
Practice Address - Country:US
Practice Address - Phone:251-990-1922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25184207RN0300X, 208600000X
ALMD.25184208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL31-10161OtherUNITED HEALTH CARE
AL051553321Medicare ID - Type Unspecified
AL118678Medicaid
AL009921825Medicaid
AL51515624OtherBLUE CROSS
H80156Medicare UPIN
AL511-04158OtherBCBS
FL267641900Medicaid
AL51515616OtherBLUE CROSS
MS06659314Medicaid
AL102I399392Medicare PIN
AL009921815Medicaid
AL102I392411Medicare PIN
ALP00027027Medicare ID - Type UnspecifiedMEDICARE RAILROAD
LA1165905Medicaid
ALP00864738Medicare PIN
AL511-04664OtherBCBS
AL1942254149OtherTRICARE SOUTH
AL118677Medicaid