Provider Demographics
NPI:1356332480
Name:MANILLA, ANTHONY CHRISTOPHER (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CHRISTOPHER
Last Name:MANILLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 MEDICAL CAMPUS RD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6700
Mailing Address - Country:US
Mailing Address - Phone:301-714-4375
Mailing Address - Fax:301-714-4399
Practice Address - Street 1:11110 MEDICAL CAMPUS RD
Practice Address - Street 2:SUTIE 126
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6700
Practice Address - Country:US
Practice Address - Phone:301-714-4375
Practice Address - Fax:301-714-4399
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-009417L207Y00000X
MDHO0064011207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1835072OtherHIGHMARK BLUE SHIELD NUMB
MD2173686OtherMAMSI
MA1835072OtherHIGHMARK BLUE SHIELD NUMB
MD2173686OtherMAMSI