Provider Demographics
NPI:1114923752
Name:MANSMANN, KEVIN A (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:MANSMANN
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 1:250 W LANCASTER AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1752
Mailing Address - Country:US
Mailing Address - Phone:610-644-6040
Mailing Address - Fax:610-644-7202
Practice Address - Street 1:250 W LANCASTER AVE
Practice Address - Street 2:STE 310
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1752
Practice Address - Country:US
Practice Address - Phone:610-644-6040
Practice Address - Fax:610-644-7202
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044086E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012857740002Medicaid
PA613677Medicare ID - Type Unspecified
PA0012857740002Medicaid