Healthcare Provider Details

I. General information

NPI: 1407830649
Provider Name (Legal Business Name): ERIC ROBERT MANKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 W CHESTER PIKE SUITE 300
NEWTOWN SQUARE PA
19073-2304
US

IV. Provider business mailing address

3855 W CHESTER PIKE SUITE 300
NEWTOWN SQUARE PA
19073-2304
US

V. Phone/Fax

Practice location:
  • Phone: 484-427-8000
  • Fax: 484-427-8020
Mailing address:
  • Phone: 484-427-8000
  • Fax: 484-427-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD052039L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: