MEDICARE: CHARLES J MANFRESCA DO

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	34004423	OH

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	:	1073576526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES J MANFRESCA DO

Provider Business Mailing Address
First Line	:	920 N HAMILTON RD
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-1757
Country	:	US
Telephone Number	:	614-293-2614
Fax Number	:	614-293-7001

Provider Business Practice Location Address
First Line	:	920 N HAMILTON RD
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-1757
Country	:	US
Telephone Number	:	614-293-2614
Fax Number	:	614-293-7001

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	02/28/2011

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Directions to “ CHARLES J MANFRESCA DO” Practice Location

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