Provider Demographics
NPI:1114142650
Name:STANLEY C. MANNINO, M.D., INC.
Entity Type:Organization
Organization Name:STANLEY C. MANNINO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANNINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-723-3360
Mailing Address - Street 1:485 COLLIERS WAY
Mailing Address - Street 2:SUITE K
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5012
Mailing Address - Country:US
Mailing Address - Phone:304-723-3360
Mailing Address - Fax:304-723-0569
Practice Address - Street 1:485 COLLIERS WAY
Practice Address - Street 2:SUITE K
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5012
Practice Address - Country:US
Practice Address - Phone:304-723-3360
Practice Address - Fax:304-723-0569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13828207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001164895-0006Medicaid
OH2414113Medicaid
WV0207532000Medicaid
PA102111709-0001Medicaid
WV0084201000Medicaid
1356503486OtherDARLENE SPERLAZZA, RN MSN FNP-BC
OH2450600Medicaid
OH2450600Medicaid
PA001164895-0006Medicaid
WV0084201000Medicaid
OHST9369581Medicare PIN
WVST9369041Medicare PIN
1356503486OtherDARLENE SPERLAZZA, RN MSN FNP-BC
B42645Medicare UPIN
OH935563Medicare ID - Type Unspecified
WV0207532000Medicaid
PA028089YS1Medicare PIN
WVNA4170114Medicare PIN