Provider Demographics
NPI:1316271935
Name:MANGIARACINA, MELCHIORRA M (DO)
Entity type:Individual
Prefix:DR
First Name:MELCHIORRA
Middle Name:M
Last Name:MANGIARACINA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 N 85TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5957
Mailing Address - Country:US
Mailing Address - Phone:407-921-1703
Mailing Address - Fax:
Practice Address - Street 1:3519 N 85TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5957
Practice Address - Country:US
Practice Address - Phone:407-921-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine