Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 025678 | CT |
NPI | 1255348025 |
---|---|
Provider Name | Dr. Kenneth Eli Mancher |
First Address | Seymour, CT 06483-3320 |
Second Address | Seymour, CT 06483-3320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 31/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001070 | HEALTHNET (01) | CT |
001256783 | (05) | CT |
010025678 | ANTHEM (01) | CT |
0796894 | CIGNA (01) | CT |
759954 | CONNECTICARE (01) | CT |
B83311 | (02) | CT |
P402416 | OXFORD (01) | CT |