Healthcare Provider Details

I. General information

NPI: 1962643882
Provider Name (Legal Business Name): MARC JOSEPH MANCINELLI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HOLLAND ST
ERIE PA
16507-1526
US

IV. Provider business mailing address

215 HOLLAND ST
ERIE PA
16507-1526
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-3018
  • Fax: 814-877-7469
Mailing address:
  • Phone: 814-877-3018
  • Fax: 814-877-7469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS014383
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberOS014383
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: