Healthcare Provider Details

I. General information

NPI: 1417148024
Provider Name (Legal Business Name): DARRIN RICHARD MANGIACARNE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7859 LAKE WORTH RD
LAKE WORTH FL
33467-3225
US

IV. Provider business mailing address

225 N FEDERAL HWY
POMPANO BEACH FL
33062-4319
US

V. Phone/Fax

Practice location:
  • Phone: 561-465-1000
  • Fax:
Mailing address:
  • Phone: 561-465-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number0102203536
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOS014185
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number21086
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number02004594A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOS14247
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: