Healthcare Provider Details

I. General information

NPI: 1013931526
Provider Name (Legal Business Name): PATRICK JOHANNES MANSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1562 OPOSSUMTOWN PIKE
FREDERICK MD
21702-4337
US

IV. Provider business mailing address

1562 OPOSSUMTOWN PIKE
FREDERICK MD
21702-4337
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-8477
  • Fax:
Mailing address:
  • Phone: 301-662-8477
  • Fax: 301-662-4293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number52362
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number52362
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberD0051559
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD0051559
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: