Provider Demographics
NPI:1538136221
Name:MANCIA, BONITA M (MD)
Entity Type:Individual
Prefix:DR
First Name:BONITA
Middle Name:M
Last Name:MANCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5500
Mailing Address - Country:US
Mailing Address - Phone:570-288-6521
Mailing Address - Fax:570-288-8284
Practice Address - Street 1:440 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5500
Practice Address - Country:US
Practice Address - Phone:570-288-6521
Practice Address - Fax:570-288-8284
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022345E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000084470OtherHIGHMARK
PA001398160-0003Medicaid
PA824196OtherFIRST PRIORITY HEALTH
PA000000266747OtherUNISON
PA0013981600001Medicaid
PA824196OtherFIRST PRIORITY HEALTH
PA000000266747OtherUNISON
PA151310ZDEEMedicare PIN