Provider Demographics
NPI:1578734547
Name:MANOLISA T CORNEL- MANALOTO MD PLC
Entity Type:Organization
Organization Name:MANOLISA T CORNEL- MANALOTO MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANOLISA
Authorized Official - Middle Name:TANDOC
Authorized Official - Last Name:CORNEL- MANALOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-499-9655
Mailing Address - Street 1:12710 DARBY BROOK CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2486
Mailing Address - Country:US
Mailing Address - Phone:703-499-9655
Mailing Address - Fax:703-499-9535
Practice Address - Street 1:12710 DARBY BROOK CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2486
Practice Address - Country:US
Practice Address - Phone:703-499-9655
Practice Address - Fax:703-499-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty