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General NPI Number Information
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NPI Number | 1891716403
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Entity Type | Individual
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Provider Name | STEPHEN P MANISCALCO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 9201 PINECROFT DR SUITE 210
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City | SHENANDOAH
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State | TX
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Zip | 77380-3222
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Country | US
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Telephone | 936-441-1010
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Fax | 832-442-3081
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Provider Business Mailing Address
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Address Line | 920 MEDICAL PLAZA DR STE 360
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City | SHENANDOAH
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State | TX
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Zip | 77380-3271
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Country | US
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Telephone | 281-803-8482
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Fax | 281-803-8432
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | L1655
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License Number State | TX
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