MEDICARE: GEORGE MANJA 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	207R00000X	Internal Medicine Physician	MD058653L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	885135	OTHER	PA	HIGHMARK BS OF PA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346242773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE MANJA M.D.

Provider Business Mailing Address
First Line	:	430 NAZARETH PIKE
Second Line	:
City	:	NAZARETH
State	:	PA
Zip	:	18064-9615
Country	:	US
Telephone Number	:	610-365-2300
Fax Number	:	610-265-8363

Provider Business Practice Location Address
First Line	:	430 NAZARETH PIKE
Second Line	:
City	:	NAZARETH
State	:	PA
Zip	:	18064
Country	:	US
Telephone Number	:	610-365-2300
Fax Number	:	610-365-8363

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	01/09/2014

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