Provider Demographics
NPI:1083614705
Name:MANNHERZ, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:MANNHERZ
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 1:283 SECOND STREET PIKE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3823
Mailing Address - Country:US
Mailing Address - Phone:215-355-7220
Mailing Address - Fax:215-355-7222
Practice Address - Street 1:283 SECOND STREET PIKE
Practice Address - Street 2:SUITE 120
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3823
Practice Address - Country:US
Practice Address - Phone:215-355-7220
Practice Address - Fax:215-355-7222
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023794E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009529910001Medicaid
C29498Medicare UPIN
PA421974Medicare PIN