Provider Demographics
NPI:1023065240
Name:MANGONE, PETER G (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:MANGONE
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 1:1515 LOCUST ST STE 350
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-5131
Mailing Address - Country:US
Mailing Address - Phone:412-232-9080
Mailing Address - Fax:
Practice Address - Street 1:1350 LOCUST ST STE 220
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-4738
Practice Address - Country:US
Practice Address - Phone:412-232-9080
Practice Address - Fax:412-232-9075
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900595207X00000X, 207XX0004X
PAMD484967207XX0004X
PAMD4844967207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12024OtherBCBS
NC8912024Medicaid
NC2270465Medicare PIN
NC8912024Medicaid
NC200035338Medicare PIN