MEDICARE: DR. JEFFREY DAVID MANSER 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
1	208000000X	Pediatrics Physician	35055578	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1437111812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY DAVID MANSER MD

Provider Business Mailing Address
First Line	:	1150 W LOCUST ST
Second Line	:
City	:	WILMINGTON
State	:	OH
Zip	:	45177-2572
Country	:	US
Telephone Number	:	937-535-7878
Fax Number	:	513-487-4849

Provider Business Practice Location Address
First Line	:	1150 W LOCUST ST
Second Line	:
City	:	WILMINGTON
State	:	OH
Zip	:	45177-2572
Country	:	US
Telephone Number	:	937-535-7878
Fax Number	:	513-487-4849

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	11/20/2024

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