Healthcare Provider Details

I. General information

NPI: 1255376786
Provider Name (Legal Business Name): ROBIN JEAN MCALISTER MANGIONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN MCALISTER

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 ASHVILLE AVE
CARY NC
27518-6130
US

IV. Provider business mailing address

2920 HIGHWOODS BLVD
RALEIGH NC
27604-0010
US

V. Phone/Fax

Practice location:
  • Phone: 919-859-1136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberC7949
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD192324
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1255376786
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 2
Identifier100072580A
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer
# 3
Identifier119187001
Identifier TypeMEDICAID
Identifier StateAR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: