MEDICARE: DR. JAMES WARREN MANSBERGER 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	208000000X	Pediatrics Physician	0S010062L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001543462	OTHER	PA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821080979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES WARREN MANSBERGER DO

Provider Business Mailing Address
First Line	:	10663 RAYSTOWN RD
Second Line	:	SUITE B
City	:	HUNTINGDON
State	:	PA
Zip	:	16652-7542
Country	:	US
Telephone Number	:	814-627-0071
Fax Number	:	814-627-0315

Provider Business Practice Location Address
First Line	:	10663 RAYSTOWN RD
Second Line	:	SUITE B
City	:	HUNTINGDON
State	:	PA
Zip	:	16652-7542
Country	:	US
Telephone Number	:	814-627-0071
Fax Number	:	814-627-0315

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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