Healthcare Provider Details

I. General information

NPI: 1598290322
Provider Name (Legal Business Name): JOANNA-CRISA MANGIO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2017
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE
BOSTON MA
02130-4817
US

IV. Provider business mailing address

150 S HUNTINGTON AVE
BOSTON MA
02130-4817
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036.161486
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: