Healthcare Provider Details

I. General information

NPI: 1871778126
Provider Name (Legal Business Name): IRAKLI MANIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHAMBERS HILL DR STE 200
CHAMBERSBURG PA
17201-7301
US

IV. Provider business mailing address

111 CHAMBERS HILL DR STE 200
CHAMBERSBURG PA
17201-7304
US

V. Phone/Fax

Practice location:
  • Phone: 717-709-7930
  • Fax: 717-709-7931
Mailing address:
  • Phone: 717-709-7922
  • Fax: 717-263-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD432736
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: