MEDICARE: POUYAN MAANY

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	122300000X	Dentist	DS037065	PA

General Provider Information

NPI Number	:	1598094757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POUYAN MAANY

Provider Business Mailing Address
First Line	:	2 LOCUST WAY
Second Line	:
City	:	LAFAYETTE HILL
State	:	PA
Zip	:	19444-2435
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	933 N CHARLOTTE ST
Second Line	:	SUITE 2D
City	:	POTTSTOWN
State	:	PA
Zip	:	19464-3974
Country	:	US
Telephone Number	:	610-326-8785
Fax Number	:

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

Provider Enumeration Date	:	12/17/2009
Last Update Date	:	12/17/2009

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Directions to “ POUYAN MAANY ” Practice Location

Language	Start Address	Practice Location

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