Provider Demographics
NPI:1518949221
Name:MANNAL, RICHARD KNOLL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KNOLL
Last Name:MANNAL
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 1:72 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2491
Mailing Address - Country:US
Mailing Address - Phone:508-824-1824
Mailing Address - Fax:
Practice Address - Street 1:99 KATHERINE RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-3213
Practice Address - Country:US
Practice Address - Phone:508-790-9407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA171420OtherHPHC
MA793303OtherTUFTS
MA2043882Medicaid
MA9709720Medicaid
MA2043882Medicaid
MA171420OtherHPHC
MAB75409Medicare UPIN