Provider Demographics
NPI:1841293396
Name:MANGINO, PATRICK NICHOLAS (AUD, FAAA)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:NICHOLAS
Last Name:MANGINO
Suffix:
Gender:M
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 SMOKE BURR DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4515
Mailing Address - Country:US
Mailing Address - Phone:614-891-6558
Mailing Address - Fax:
Practice Address - Street 1:1180 SMOKE BURR DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4515
Practice Address - Country:US
Practice Address - Phone:614-891-6558
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA0018231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2125355Medicaid
OH0527432Medicare ID - Type UnspecifiedAUDIOLOGY