MEDICARE: DR. RALPH MICHAEL MANCINI M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	E7178	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	89G540	OTHER	TX	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881646974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH MICHAEL MANCINI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 925510
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77292-5510
Country	:	US
Telephone Number	:	713-984-9595
Fax Number	:	713-984-8576

Provider Business Practice Location Address
First Line	:	1044 CANDLELIGHT LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-2004
Country	:	US
Telephone Number	:	713-984-9595
Fax Number	:	713-984-8576

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	04/17/2013

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