Healthcare Provider Details

I. General information

NPI: 1114308608
Provider Name (Legal Business Name): MATTHEW MANGINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 RED BANK RD STE 110
CINCINNATI OH
45227-2173
US

IV. Provider business mailing address

4460 RED BANK RD STE 110
CINCINNATI OH
45227-2173
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-5200
  • Fax: 513-791-5229
Mailing address:
  • Phone: 513-791-5200
  • Fax: 513-791-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036169837
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01092559A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.153969
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number35.153969
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number01092559A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number036169837
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: