Provider Demographics
NPI:1467466490
Name:MANGILI, VINCENT (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:MANGILI
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 1:163 LIBBEY INDUSTRIAL PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3137
Mailing Address - Country:US
Mailing Address - Phone:781-337-4224
Mailing Address - Fax:781-335-0429
Practice Address - Street 1:163 LIBBEY INDUSTRIAL PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3137
Practice Address - Country:US
Practice Address - Phone:781-337-4224
Practice Address - Fax:781-335-0429
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA75633207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA05005274OtherPALMETTO GBA
MAJ12315OtherBLUE SHIELD
MA075633OtherTUFTS HEALTH PLAN
MA3101398Medicaid
MA39094OtherFALLON
MA275182OtherHARVARD PILGRIM
MAF25287OtherTRICARE
MA3101398OtherHEALTHY START
MAJ12315OtherBLUE SHIELD
MA05005274OtherPALMETTO GBA
MA3101398OtherHEALTHY START
MAF25287Medicare UPIN