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NPI Code Detail

MEDICARE: MICHELLE MANWARE P.A.

MEDICARE: MICHELLE MANWARE P.A.
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 Assistant1383MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11383OTHERMALICENCE

General Provider Information

NPI Number : 1366400541
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE MANWARE P.A.
Provider Business Mailing Address
First Line : 100 ARMSTRONG RD
Second Line :
City : PLYMOUTH
State : MA
Zip : 02360-7219
Country : US
Telephone Number : 503-830-6116
Fax Number : 508-747-6308
Provider Business Practice Location Address
First Line : 118 LONG POND RD
Second Line : JORDAN HOSPITAL OB-GYN
City : PLYMOUTH
State : MA
Zip : 02360-2662
Country : US
Telephone Number : 508-830-3160
Fax Number : 781-340-3782
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 02/18/2013

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Directions to “ MICHELLE MANWARE P.A.” Practice Location

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