MEDICARE: KRISTEN DENISE MANTER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	228042	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	112467268MA01	OTHER	CAREPLUS
2	PPO5996243	OTHER	GHI
3	204590101	OTHER	HEALTHPLUS
4	P3614958	OTHER	OXFORD
5	40426028484	OTHER	FIDELIS
6	PC4845	OTHER	CENTERCARE CHP
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023084571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN DENISE MANTER MD

Provider Business Mailing Address
First Line	:	PO BOX 746087
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6087
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:

Provider Business Practice Location Address
First Line	:	1249 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3844
Country	:	US
Telephone Number	:	718-765-6008
Fax Number	:	347-682-4219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	11/12/2024

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