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NPI Code Detail

MEDICARE: DR. MARY JANE MANGEN MD

MEDICARE: DR. MARY JANE MANGEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry Physician35058814OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205882263
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY JANE MANGEN MD
Provider Business Mailing Address
First Line : 725 S SHOOP AVE
Second Line :
City : WAUSEON
State : OH
Zip : 43567-1702
Country : US
Telephone Number : 419-335-2015
Fax Number : 419-330-2774
Provider Business Practice Location Address
First Line : 725 S SHOOP AVE
Second Line :
City : WAUSEON
State : OH
Zip : 43567-1702
Country : US
Telephone Number : 419-335-2015
Fax Number : 419-330-2774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2006
Last Update Date : 07/28/2016

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Directions to “ DR. MARY JANE MANGEN MD” Practice Location

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