MEDICARE: DR. THOMAS LOUIS MANZO 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	207W00000X	Ophthalmology Physician	MD-016446-E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0045453000	OTHER	PA	KEYSTONE HEALTH PLAN EAST
2	2804	OTHER	PA	AETNA
3	5438468	OTHER	PA	CIGNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073515888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS LOUIS MANZO M.D.

Provider Business Mailing Address
First Line	:	1329 E HIGH ST
Second Line	:
City	:	POTTSTOWN
State	:	PA
Zip	:	19464-4949
Country	:	US
Telephone Number	:	610-326-4044
Fax Number	:	610-326-6901

Provider Business Practice Location Address
First Line	:	1329 E HIGH ST
Second Line	:
City	:	POTTSTOWN
State	:	PA
Zip	:	19464-4949
Country	:	US
Telephone Number	:	610-326-4044
Fax Number	:	610-326-6901

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	02/20/2008

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