Provider Demographics
NPI:1447216924
Name:MANGANO, ANTHONY R (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:R
Last Name:MANGANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9521 MALLORY RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-3819
Mailing Address - Country:US
Mailing Address - Phone:716-725-5140
Mailing Address - Fax:317-922-7012
Practice Address - Street 1:9521 MALLORY RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-3819
Practice Address - Country:US
Practice Address - Phone:716-725-5140
Practice Address - Fax:315-922-7012
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2261732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00026269101OtherUNIVERA
BM7996599OtherDEA
P010226172OtherBLUE CHOICE
0140611OtherGHI
1611616OtherINDEPENDENT HEALTH
4105275OtherGHI
040426003192OtherFIDELIS
000527299005OtherBLUE SHIELD WNY
NY02389215Medicaid
NY2261733WOtherWORKERS COMPENSATION
P00029523OtherRR MEDICARE
P020226173OtherBLUE SHIED ROCHESTER
197608FFOtherPREFERRED CARE
P00131609OtherRR MEDICARE
00026269103OtherUNIVERA
000527299001OtherBLUE SHIELD WNY
P00131609OtherRR MEDICARE
P010226172OtherBLUE CHOICE
NYH82526Medicare UPIN