Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 012224 | OH |
NPI | 1376810044 |
---|---|
Provider Name | Dr. Antonio G Manocchio JR. |
First Address | New Albany, OH 43054-8195 |
Second Address | Dayton, OH 45405-4720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2011 |
Last Update Date | 12/06/2017 |