Basic Information
| Provider Information | |||||||||
| NPI: | 1023065240 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANGONE | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 129 MCDOWELL ST | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282588800 | ||||||||
| FaxNumber: | 8282817178 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 LIVINGSTON ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282588800 | ||||||||
| FaxNumber: | 8282817178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 05/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 9900595 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0004X | 9900595 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 12024 | 01 | NC | BCBS | OTHER | 8912024 | 05 | NC | MEDICAID |