Provider Demographics
NPI:1467892794
Name:MANNAN, SUNJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNJAY
Middle Name:
Last Name:MANNAN
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 1:20826 ROUTE 19
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6028
Mailing Address - Country:US
Mailing Address - Phone:724-776-4776
Mailing Address - Fax:724-776-0251
Practice Address - Street 1:20826 ROUTE 19
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066
Practice Address - Country:US
Practice Address - Phone:724-776-4776
Practice Address - Fax:724-776-0251
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27112207P00000X
PAMD458000207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103213230Medicaid
PAMD458000OtherMEDICAL LISC