Individual
DR. CHARLES M MANGANIELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
605 MAIN ST, DURYEA, PA 18642-1325
(570) 457-1110
Mailing address
PO BOX 1388, KINGSTON, PA 18704-0379
(570) 288-8881
(570) 288-8065
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
MD037791L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001216
FIRST PRIORITY HEALTH
PA
05
—
0013919460001
—
PA
01
—
020338000
BLACK LUNG
PA
01
—
024946
FIRST PRIORITY LIFE INS C
PA
01
—
14821 E222
GEISINGER HEALTH PLAN
PA
Enumeration date
07/08/2005
Last updated
03/25/2020
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