Healthcare Provider Details

I. General information

NPI: 1104084144
Provider Name (Legal Business Name): LAURA M MANTINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 LIBERTY AVE SUITE GR-30
PITTSBURGH PA
15224-2156
US

IV. Provider business mailing address

131 PLEASANT DR SUITE I
ALIQUIPPA PA
15001-1384
US

V. Phone/Fax

Practice location:
  • Phone: 412-621-3844
  • Fax: 412-683-8560
Mailing address:
  • Phone: 724-379-5400
  • Fax: 724-302-2091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD432550
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: