Provider Demographics
NPI:1508847575
Name:IBANEZ-MANLAPAZ, IRENE G (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:G
Last Name:IBANEZ-MANLAPAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:IBANEZ-MANLAPAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MBA
Mailing Address - Street 1:1700 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7529
Mailing Address - Country:US
Mailing Address - Phone:717-272-6621
Mailing Address - Fax:717-228-5962
Practice Address - Street 1:1700 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7529
Practice Address - Country:US
Practice Address - Phone:717-272-6621
Practice Address - Fax:717-228-5962
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07991R207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11-00103OtherUNITED HEALTHCARE
LA1441996Medicaid
LA721134010BOtherHUMANA
1069922OtherCIGNA
LA1100170Medicaid
LA721134010OtherTRICARE
LA220012016OtherPALMETTO GBA - RRMC
1069922OtherCIGNA
LA11-00103OtherUNITED HEALTHCARE
LA5J685Medicare PIN