Provider Demographics
NPI:1063513885
Name:MANGIERI, EUGENE A (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:A
Last Name:MANGIERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476
Mailing Address - Country:US
Mailing Address - Phone:205-339-9000
Mailing Address - Fax:205-339-4423
Practice Address - Street 1:2510 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476
Practice Address - Country:US
Practice Address - Phone:205-339-9000
Practice Address - Fax:205-339-4423
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15035207L00000X
AL17347207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528702190Medicaid
AL528702190Medicaid
C71481Medicare UPIN