MEDICARE: RICHARD A MANCH M.D.

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	207RG0100X	Gastroenterology Physician	7079	AZ
2	207RI0008X	Hepatology Physician	7079	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043289341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD A MANCH M.D.

Provider Business Mailing Address
First Line	:	2201 W FAIRVIEW ST STE 9
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-4711
Country	:	US
Telephone Number	:	480-407-4000
Fax Number	:	480-686-8875

Provider Business Practice Location Address
First Line	:	6677 THUNDERBIRD ROAD
Second Line	:	BUILDING G, #116
City	:	GLENDALE
State	:	AZ
Zip	:	85306
Country	:	US
Telephone Number	:	148-068-6887
Fax Number	:

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	01/12/2020

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