Basic Information
| Provider Information | |||||||||
| NPI: | 1932563327 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANGAN | ||||||||
| FirstName: | JOHN | ||||||||
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| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 CHESTNUT ST | ||||||||
| Address2: | SUITE 801 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159551500 | ||||||||
| FaxNumber: | 2155030530 | ||||||||
| Practice Location | |||||||||
| Address1: | 9500 EUCLID AVE # S40 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441954216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164459234 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2016 | ||||||||
| LastUpdateDate: | 09/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | 35.142558 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
No ID Information.