Individual
DR. CHARLES A. MANGHAM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MS
Contact information
Practice address
801 BROADWAY, STE 830, SEATTLE, WA 98122-4396
(206) 328-4327
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207YX0901X
Otology & Neurotology Physician
Primary
MD00013302
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1130606
—
WA
01
—
MD00013302
STATE MEDICAL LICENSE
WA
Enumeration date
04/03/2006
Last updated
03/07/2023
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