Active NPI
Marisa M Mancuso, DO
- Pediatrics Physician
- Boardman, OH
National Provider Identifier
1124647516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 34.016662
- Practice address
- 6505 Market St
Boardman, OH 44512-1063 - Phone
- (330) 543-8178
- NPI assigned
- Apr 15, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | 34.016662 | OH | Primary |
Addresses
Primary practice location
6505 Market St
Boardman, OH 44512-1063
Mailing address
1 Perkins SQ
Akron, OH 44308-1063
Phone (440) 476-5722
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
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34.016662 | OH | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Hospital Medical Center of Akron | Past | Accepting new patients | |
| Mercy Health Youngstown LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Children's Hospital
- Akron, OH
- NPI 1861506560
-
- General Acute Care Hospital
- Youngstown, OH
- NPI 1790868982
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687564800000",
"number": "1124647516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 PERKINS SQ",
"city": "AKRON",
"state": "OH",
"postal_code": "443081063",
"telephone_number": "440-476-5722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6505 MARKET ST",
"city": "BOARDMAN",
"state": "OH",
"postal_code": "445121063",
"telephone_number": "330-543-8178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANCUSO",
"first_name": "MARISA",
"middle_name": "M",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-15",
"last_updated": "2023-06-24",
"certification_date": "2023-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "34.016662",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boardman, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.