Basic Information
| Provider Information | |||||||||
| NPI: | 1447216924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANGANO | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1368 | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142311368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168592954 | ||||||||
| FaxNumber: | 7168592962 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142031126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168592954 | ||||||||
| FaxNumber: | 7168592962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 05/06/2008 | ||||||||
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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 | 2085R0202X | 226173 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1611616 | 01 | INDEPENDENT HEALTH | OTHER | P00029523 | 01 | RR MEDICARE | OTHER | 000527299001 | 01 | BLUE SHIELD WNY | OTHER | 000527299005 | 01 | BLUE SHIELD WNY | OTHER | P00131609 | 01 | RR MEDICARE | OTHER | 197608FF | 01 | PREFERRED CARE | OTHER | 2261733W | 01 | NY | WORKERS COMPENSATION | OTHER | P020226173 | 01 | BLUE SHIED ROCHESTER | OTHER | 4105275 | 01 | GHI | OTHER | 00026269103 | 01 | UNIVERA | OTHER | 0140611 | 01 | GHI | OTHER | P010226172 | 01 | BLUE CHOICE | OTHER | 00026269101 | 01 | UNIVERA | OTHER | 02389215 | 05 | NY | MEDICAID | 040426003192 | 01 | FIDELIS | OTHER |