MEDICARE: MARK A MANEGOLD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	35-051751	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100010946	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396749891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A MANEGOLD M.D.

Provider Business Mailing Address
First Line	:	3219 CLIFTON AVE STE 330
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-2452
Country	:	US
Telephone Number	:	513-853-9250
Fax Number	:	513-281-1908

Provider Business Practice Location Address
First Line	:	3219 CLIFTON AVE STE 330
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-2452
Country	:	US
Telephone Number	:	513-853-9250
Fax Number	:	513-281-1908

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	06/28/2023

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Directions to “ MARK A MANEGOLD M.D.” Practice Location

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