Healthcare Provider Details

I. General information

NPI: 1922305952
Provider Name (Legal Business Name): MARY DONNA MANANGHAYA CRUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 8TH AVE
BETHLEHEM PA
18018-2256
US

IV. Provider business mailing address

1469 8TH AVE
BETHLEHEM PA
18018-2256
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-7800
  • Fax: 866-732-7151
Mailing address:
  • Phone: 484-526-7800
  • Fax: 866-732-7151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA09958100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD472088
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number25MA09958100
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberMD472088
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: