Healthcare Provider Details

I. General information

NPI: 1851362537
Provider Name (Legal Business Name): AINSLY OLIVER MANNING PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 STATE ST
LUDLOW MA
01056-3437
US

IV. Provider business mailing address

819 WORCESTER ST SUITE 3
SPRINGFIELD MA
01151-1045
US

V. Phone/Fax

Practice location:
  • Phone: 413-308-3300
  • Fax: 413-308-3601
Mailing address:
  • Phone: 413-543-6820
  • Fax: 413-543-7962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601012910
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3040
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA066762
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01771
License Number StateRI
# 5
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1161
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110010875
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0009879
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: