MEDICARE: MANI MEDICAL SERVICES LLC

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	207RG0100X	Gastroenterology Physician	MD072873L	PA

General Provider Information

NPI Number	:	1538336466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANI MEDICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	204 TREMAIN RD
Second Line	:
City	:	BENSALEM
State	:	PA
Zip	:	19020-1642
Country	:	US
Telephone Number	:	608-312-1097
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 W GIRARD AVE
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1615
Country	:	US
Telephone Number	:	215-787-9503
Fax Number	:	215-787-9164

Authorized Official
Title or Position	:	GASTROENTEROLOGIST
Name	:	DR. ATIA S HASHIM
Credential	:	M.D.
Telephone Number	:	608-312-1097

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	05/09/2008

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