=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780685677
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN DANA MANNION M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 S GOVERNORS AVE SUITE 101A
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19904-3530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-744-7980
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 704 GREEN WINGED TRL
-----------------------------------------------------
City | CAMDEN WYOMING
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19934-9530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-697-1377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number | C1-0007255
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------