Provider Demographics
NPI:1073567293
Name:MANCI, ELIZABETH A (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MANCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-415-1612
Mailing Address - Fax:251-415-1003
Practice Address - Street 1:1700 CENTER ST
Practice Address - Street 2:PATHOLOGY
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3301
Practice Address - Country:US
Practice Address - Phone:251-415-1612
Practice Address - Fax:251-415-1003
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL4531207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000014411Medicaid
MS00018680Medicaid
AL11-10126OtherUNITED HEALTH CARE
LA1052477Medicaid
AL51014411OtherBLUE CROSS
FL255642100Medicaid
C78516Medicare UPIN
FL255642100Medicaid