Provider Demographics
NPI:1275527269
Name:MAN-HSIAO, IRENE (DO)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:MAN-HSIAO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1654
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0654
Mailing Address - Country:US
Mailing Address - Phone:570-474-6093
Mailing Address - Fax:570-474-9342
Practice Address - Street 1:5024 OLD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-3236
Practice Address - Country:US
Practice Address - Phone:570-450-5025
Practice Address - Fax:570-450-0100
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014215208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics