Provider Demographics
NPI:1588612139
Name:MANKO, GARY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALAN
Last Name:MANKO
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:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-2516
Practice Address - Country:US
Practice Address - Phone:410-526-3041
Practice Address - Fax:410-584-2258
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD25062207R00000X
CODR.0069745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD266471200Medicaid
157892ZR0ZMedicare PIN
MDL066Medicare PIN
MD110031861Medicare PIN
MD157676Medicare PIN
MDC49260Medicare UPIN