MEDICARE: JOHN MANENTI DO

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	207P00000X	Emergency Medicine Physician	34004777	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00319483	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000383091	OTHER	OH	ANTHEM
3	000000349348	OTHER	OH	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000385524	OTHER	OH	ANTHEM
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	000000385522	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1720065071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MANENTI DO

Provider Business Mailing Address
First Line	:	5700 DARROW RD
Second Line	:	SUITE 106
City	:	HUDSON
State	:	OH
Zip	:	44236-5021
Country	:	US
Telephone Number	:	330-656-5911
Fax Number	:	330-656-5901

Provider Business Practice Location Address
First Line	:	5533 MAHONING AVE FL 2
Second Line	:
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-2366
Country	:	US
Telephone Number	:	330-793-2707
Fax Number	:

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	07/01/2022

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Directions to “ JOHN MANENTI DO” Practice Location

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