Basic Information
| Provider Information | |||||||||
| NPI: | 1477548675 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANGIALARDI | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 23RD AVE N | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153425900 | ||||||||
| FaxNumber: | 6153426086 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 23RD AVE N | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153425900 | ||||||||
| FaxNumber: | 6153426086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 06/11/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | MD27110 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | MD27110 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 3095731 | 05 | TN | MEDICAID | 6402953100 | 05 | KY | MEDICAID |