Provider Demographics
NPI:1083888481
Name:SKOW, MANUEL (PA)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:SKOW
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:7711 QUARTERFIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4492
Practice Address - Country:US
Practice Address - Phone:410-761-5560
Practice Address - Fax:410-761-5734
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0003640363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00716609OtherRR MEDICARE
MD13167ZARMedicare PIN