Provider Demographics
NPI:1073515888
Name:MANZO, THOMAS LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LOUIS
Last Name:MANZO
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 1:1329 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-4949
Mailing Address - Country:US
Mailing Address - Phone:610-326-4044
Mailing Address - Fax:610-326-6901
Practice Address - Street 1:1329 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-4949
Practice Address - Country:US
Practice Address - Phone:610-326-4044
Practice Address - Fax:610-326-6901
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-016446-E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0045453000OtherKEYSTONE HEALTH PLAN EAST
PA2804OtherAETNA
PA5438468OtherCIGNA
PA0622314Medicaid
PA0622314Medicaid
049756XP5Medicare PIN