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NPI Code Detail

MEDICARE: EDNA M MANALO PA

MEDICARE: EDNA M MANALO PA
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
1363A00000XPhysician Assistant10000418AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01146780OTHERINRAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number : 1265410120
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDNA M MANALO PA
Provider Business Mailing Address
First Line : 6920 POINTE INVERNESS WAY STE 200
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7934
Country : US
Telephone Number : 260-479-3516
Fax Number : 260-479-3520
Provider Business Practice Location Address
First Line : 2516 E DUPONT RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-1608
Country : US
Telephone Number : 260-471-7197
Fax Number : 260-471-7408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2006
Last Update Date : 10/13/2020

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Directions to “ EDNA M MANALO PA” Practice Location

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