MEDICARE: MICHELLE MANWARE P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1383	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1383	OTHER	MA	LICENCE

General Provider Information

NPI Number	:	1366400541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MANWARE P.A.

Provider Business Mailing Address
First Line	:	100 ARMSTRONG RD
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-7219
Country	:	US
Telephone Number	:	503-830-6116
Fax Number	:	508-747-6308

Provider Business Practice Location Address
First Line	:	118 LONG POND RD
Second Line	:	JORDAN HOSPITAL OB-GYN
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2662
Country	:	US
Telephone Number	:	508-830-3160
Fax Number	:	781-340-3782

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	02/18/2013

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Directions to “ MICHELLE MANWARE P.A.” Practice Location

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