Provider Demographics
NPI:1780800250
Name:MACANGA, EDWARD JR (DM)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:MACANGA
Suffix:JR
Gender:M
Credentials:DM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1943
Mailing Address - Country:US
Mailing Address - Phone:440-826-1440
Mailing Address - Fax:
Practice Address - Street 1:255 FRONT ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1943
Practice Address - Country:US
Practice Address - Phone:440-826-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3639172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist