Active NPI
Micaela Manganello
- Addiction Medicine (Preventive Medicine) Physician
- South Portland, ME
National Provider Identifier
1063384907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction Medicine (Preventive Medicine) Physician
- License
- RN72898
- Practice address
- 400 Western Ave
South Portland, ME 04106-1704 - Phone
- (207) 292-1306
- NPI assigned
- Sep 20, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Preventive Medicine) Physician | 2083A0300X | RN72898 | ME | Primary |
Addresses
Primary practice location
400 Western Ave
South Portland, ME 04106-1704
Mailing address
50 Adams St Apt 1
Biddeford, ME 04005-2995
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN72898 | ME | MD | Addiction Medicine (Preventive Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1758326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758326400000",
"number": "1063384907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 ADAMS ST APT 1",
"city": "BIDDEFORD",
"state": "ME",
"postal_code": "040052995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 WESTERN AVE",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041061704",
"telephone_number": "207-292-1306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGANELLO",
"first_name": "MICAELA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-20",
"last_updated": "2025-09-20",
"certification_date": "2025-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "2083A0300X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Addiction Medicine",
"state": "ME",
"license": "RN72898",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.