Provider Demographics
NPI:1487645727
Name:MANNINO, STANLEY C (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:C
Last Name:MANNINO
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 1:485 COLLIERS WAY
Mailing Address - Street 2:SUITE K
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5012
Mailing Address - Country:US
Mailing Address - Phone:304-723-3360
Mailing Address - Fax:304-723-0569
Practice Address - Street 1:485 COLLIERS WAY
Practice Address - Street 2:SUITE K
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5012
Practice Address - Country:US
Practice Address - Phone:304-723-3360
Practice Address - Fax:304-723-0569
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13828207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0084201000Medicaid
PA102111709-0001Medicaid
PA001164895-00006Medicaid
WVB42645Medicare UPIN
WV0084201000Medicaid
WV0742785Medicare ID - Type Unspecified
PA028089YS1Medicare PIN
PA127685Medicare PIN
OHST9369581Medicare PIN