Provider Demographics
NPI:1023217908
Name:MANOS, GINGER LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:GINGER
Middle Name:LYNNE
Last Name:MANOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 NW 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-4809
Mailing Address - Country:US
Mailing Address - Phone:850-398-2548
Mailing Address - Fax:850-398-2548
Practice Address - Street 1:4615 NW 53RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-4809
Practice Address - Country:US
Practice Address - Phone:850-398-2548
Practice Address - Fax:850-398-2548
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC324872086S0129X
FLME1121232086S0129X
SCMD324872086S0129X
ALMD321272086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012102000Medicaid
AL161998Medicaid
FLHV310AMedicare PIN
AL161998Medicaid