Provider Demographics
NPI:1346337086
Name:MITCHELL MANIN MD PC
Entity Type:Organization
Organization Name:MITCHELL MANIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-436-3273
Mailing Address - Street 1:3 GREENLEAF WOODS DRIVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-436-3273
Mailing Address - Fax:603-431-1615
Practice Address - Street 1:3 GREENLEAF WOODS DRIVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-436-3273
Practice Address - Fax:603-431-1615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A805211OtherVALUE OPTIONS
010007740NH01OtherANTHEM BCBS
D03373Medicare UPIN
A805211OtherVALUE OPTIONS