Provider Demographics
NPI:1295731784
Name:MANGANO, CHARLES A JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:MANGANO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3000 NEW BERN AVE
Mailing Address - Street 2:STE 1200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1231
Mailing Address - Country:US
Mailing Address - Phone:919-231-6132
Mailing Address - Fax:919-231-6276
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:STE 1200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-231-6132
Practice Address - Fax:919-231-6276
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC20042207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8953834Medicaid
060035477OtherRAILROAD MEDICARE
C85293Medicare UPIN
208467Medicare ID - Type Unspecified