Healthcare Provider Details

I. General information

NPI: 1336888486
Provider Name (Legal Business Name): ROBERT BOYD MANGES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9000
  • Fax:
Mailing address:
  • Phone: 860-545-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number1025350
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: