Provider Demographics
NPI:1245255934
Name:BOYLE-MANGANARO, MAUREEN A (MD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:A
Last Name:BOYLE-MANGANARO
Suffix:
Gender:F
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 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:201 RIDGE ST
Practice Address - Street 2:STE 312
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-396-7880
Practice Address - Fax:712-396-7885
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28036207V00000X
MO2001005627207V00000X
IAMD-43345207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO465449OtherCHILDRENS MERCY FAMILY HEALTH
NE47068731777Medicaid
476709OtherHEALTHLINK
P00036242OtherRAILROAD MEDICARE
414770OtherFIRSTGUARD
44054528964506V018OtherTRICARE/CHAMPUS
5897653OtherAETNA
10001545401OtherCOMMUNITY HEALTH PLAN
KS100402030BMedicaid
IA1245255934Medicaid
NE10026301600Medicaid
MO29689029OtherBLUE CROSS BLUE SHIELD
NE10026211300Medicaid
10001545401OtherCOMMUNITY HEALTH PLAN
MO205363609Medicare ID - Type Unspecified
MO465449OtherCHILDRENS MERCY FAMILY HEALTH
P00036242OtherRAILROAD MEDICARE
NE10026211300Medicaid