Provider Demographics
NPI:1942298427
Name:MANGIARACINA, GIACOMO (MD)
Entity Type:Individual
Prefix:
First Name:GIACOMO
Middle Name:
Last Name:MANGIARACINA
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 1:1415 HEATHER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3731
Mailing Address - Country:US
Mailing Address - Phone:609-462-7790
Mailing Address - Fax:215-550-6154
Practice Address - Street 1:1415 HEATHER RIDGE DR
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940
Practice Address - Country:US
Practice Address - Phone:609-462-7790
Practice Address - Fax:215-550-6154
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA57390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F09840Medicare UPIN