MEDICARE: EMMA CAROLINE MANGANO PMH-NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R179858	MD

General Provider Information

NPI Number	:	1750716981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA CAROLINE MANGANO PMH-NP

Provider Business Mailing Address
First Line	:	1740 YORK RD
Second Line	:	SUITE 309
City	:	LUTHERVILLE TIMONIUM
State	:	MD
Zip	:	21093-5606
Country	:	US
Telephone Number	:	410-825-2281
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 YORK RD
Second Line	:	SUITE 309
City	:	LUTHERVILLE TIMONIUM
State	:	MD
Zip	:	21093-5606
Country	:	US
Telephone Number	:	410-825-2281
Fax Number	:

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

Provider Enumeration Date	:	09/06/2013
Last Update Date	:	11/28/2023

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