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NPI Code Detail

MEDICARE: DR. LAWRENCE GEORGE MANCO MD

MEDICARE: DR. LAWRENCE GEORGE MANCO MD
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
12085R0202XDiagnostic Radiology Physician47695MA
22085R0202XDiagnostic Radiology PhysicianME83157FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00464359OTHERFLRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3ME83157OTHERFLLICENSE NO

General Provider Information

NPI Number : 1275522997
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAWRENCE GEORGE MANCO MD
Provider Business Mailing Address
First Line : 8374 MARKET ST
Second Line : BOX 502
City : LAKEWOOD RANCH
State : FL
Zip : 34202-5137
Country : US
Telephone Number : 941-955-4101
Fax Number :
Provider Business Practice Location Address
First Line : 206 2ND ST E
Second Line :
City : BRADENTON
State : FL
Zip : 34208-1042
Country : US
Telephone Number : 941-955-4101
Fax Number : 941-358-9817
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2005
Last Update Date : 11/02/2016

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