Active NPI
Martin Joseph Mangan III, MD
- Family Medicine Physician
- Lexington, KY
National Provider Identifier
1104873108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 32706
- Practice address
- 1055 Dove Run Rd
Suite 200
Lexington, KY 40502-3536 - Phone
- (859) 269-4668
- Fax
- (859) 266-5577
- NPI assigned
- May 27, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 32706 | KY | Primary |
Addresses
Primary practice location
1055 Dove Run Rd
Suite 200
Lexington, KY 40502-3536
Mailing address
1055 Dove Run Rd
Suite 200
Lexington, KY 40502-3536
Phone (859) 269-4668
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64327067 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478131200000",
"number": "1104873108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 DOVE RUN RD",
"address_2": "SUITE 200",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405023536",
"telephone_number": "859-269-4668",
"fax_number": "859-266-5577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1055 DOVE RUN RD",
"address_2": "SUITE 200",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405023536",
"telephone_number": "859-269-4668",
"fax_number": "859-266-5577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGAN",
"first_name": "MARTIN",
"middle_name": "JOSEPH",
"name_suffix": "III",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-27",
"last_updated": "2016-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KY",
"license": "32706",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64327067",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lexington, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.