Provider Demographics
NPI:1598956922
Name:MANCHESTER FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:MANCHESTER FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-374-4747
Mailing Address - Street 1:2973 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-1802
Mailing Address - Country:US
Mailing Address - Phone:410-374-4747
Mailing Address - Fax:443-507-0003
Practice Address - Street 1:2973 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-1802
Practice Address - Country:US
Practice Address - Phone:410-374-4747
Practice Address - Fax:443-507-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty