Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD022257E | PA |
NPI | 1033168729 |
---|---|
Provider Name | Mark Eric Manstein |
First Address | Huntingdon Valley, PA 19006-8365 |
Second Address | Huntingdon Valley, PA 19006-8365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 02/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005249000 | KEYSTONE (01) | PA |
1027199 | (05) | PA |
50443 | AETNA (01) | PA |
B42045 | (02) |