Provider Demographics
NPI:1881903508
Name:TODD P MANGIONE PLLC
Entity type:Organization
Organization Name:TODD P MANGIONE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:P
Authorized Official - Last Name:MANGIONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-205-5555
Mailing Address - Street 1:103 W MARION AVE
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4403
Mailing Address - Country:US
Mailing Address - Phone:941-205-5555
Mailing Address - Fax:941-205-5558
Practice Address - Street 1:103 W MARION AVE
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4403
Practice Address - Country:US
Practice Address - Phone:941-205-5555
Practice Address - Fax:941-205-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10446208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS10446OtherMEDICAL LICENSE