Provider Demographics
NPI:1033168729
Name:MANSTEIN, MARK ERIC (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ERIC
Last Name:MANSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-8365
Mailing Address - Country:US
Mailing Address - Phone:215-379-5700
Mailing Address - Fax:215-379-2520
Practice Address - Street 1:821 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 120
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-8365
Practice Address - Country:US
Practice Address - Phone:215-379-5700
Practice Address - Fax:215-379-2520
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022257E2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA005249000OtherKEYSTONE
PA50443OtherAETNA
PA1027199Medicaid
PA50443OtherAETNA
PA066429Medicare ID - Type Unspecified