Provider Demographics
NPI:1346242773
Name:MANJA, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:MANJA
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 1:430 NAZARETH PIKE
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-9615
Mailing Address - Country:US
Mailing Address - Phone:610-365-2300
Mailing Address - Fax:610-265-8363
Practice Address - Street 1:430 NAZARETH PIKE
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064
Practice Address - Country:US
Practice Address - Phone:610-365-2300
Practice Address - Fax:610-365-8363
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058653L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA885135OtherHIGHMARK BS OF PA
PA0016155750004Medicaid
PA0016155750004Medicaid
PA885135V8GMedicare PIN
PA885135Q0EMedicare PIN