MEDICARE: DR. JONATHAN MANHARD 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207W00000X	Ophthalmology Physician	042.0014302	VT

General Provider Information

NPI Number	:	1235526567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN MANHARD M.D.

Provider Business Mailing Address
First Line	:	1906 BELLEVIEW AVE SE
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-1838
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 HINESBURG RD STE 201
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-7613
Country	:	US
Telephone Number	:	802-862-1808
Fax Number	:	802-862-6664

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

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	08/21/2019

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