Provider Demographics
NPI:1447219415
Name:MANOLACHE, PETRICA (MD)
Entity Type:Individual
Prefix:
First Name:PETRICA
Middle Name:
Last Name:MANOLACHE
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:PO BOX 391414
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-8414
Mailing Address - Country:US
Mailing Address - Phone:216-491-7660
Mailing Address - Fax:440-834-1902
Practice Address - Street 1:4180 WARRENSVILLE CENTER RD
Practice Address - Street 2:BUILDING A, SUITE 120
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7024
Practice Address - Country:US
Practice Address - Phone:216-491-7660
Practice Address - Fax:440-834-1902
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076221M207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2205081Medicaid
OH2205081Medicaid