Healthcare Provider Details

I. General information

NPI: 1104805126
Provider Name (Legal Business Name): FERDINAND J MANAHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 PENN AVENUE FORUM PLAZA
SCRANTON PA
18503
US

IV. Provider business mailing address

239 PENN AVENUE FORUM PLAZA
SCRANTON PA
18503
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-6170
  • Fax: 570-346-2575
Mailing address:
  • Phone: 570-346-6170
  • Fax: 570-346-2575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD043284E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD043284E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1165195
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier505518
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA
# 3
Identifier0669043
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICAL ASSISTANCE
# 4
Identifier440302
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFIRST PRIORITY
# 5
Identifier38078
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGEISINGER HEALTH PLAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: