Provider Demographics
NPI:1508895178
Name:MANTIONE, JOHN R JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:MANTIONE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:8105 ADAMS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-8625
Mailing Address - Country:US
Mailing Address - Phone:717-482-8115
Mailing Address - Fax:717-482-8364
Practice Address - Street 1:8105 ADAMS DR
Practice Address - Street 2:SUITE B
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-8625
Practice Address - Country:US
Practice Address - Phone:717-482-8115
Practice Address - Fax:717-482-8364
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-01-07
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Provider Licenses
StateLicense IDTaxonomies
PAMD070704L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH40027Medicare UPIN