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General NPI Number Information
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NPI Number | 1720256043
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Entity Type | Organization
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Legal Business Name | BONITA M MANCIA M.D.
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 676 WYOMING AVE
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City | KINGSTON
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State | PA
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Zip | 18704-3857
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Country | US
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Telephone | 570-288-6521
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Fax |
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Provider Business Mailing Address
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Address Line | 676 WYOMING AVE
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City | KINGSTON
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State | PA
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Zip | 18704-3857
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Country | US
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Telephone | 570-288-6521
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | BONITA M MANCIA
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Credential | M.D.
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Telephone | 570-288-6521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD022345E
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License Number State | PA
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