Provider Demographics
NPI:1518964832
Name:MANTA, JOHN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:MANTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:479 THOMAS JONES WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2580
Mailing Address - Country:US
Mailing Address - Phone:610-280-9999
Mailing Address - Fax:610-363-8914
Practice Address - Street 1:479 THOMAS JONES WAY
Practice Address - Street 2:STE 300
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2580
Practice Address - Country:US
Practice Address - Phone:610-280-9999
Practice Address - Fax:610-363-8914
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD047462L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG24257Medicare UPIN
PA448641Medicare PIN