Provider Demographics
NPI:1609365386
Name:MANNAN, SOHAIB (MD)
Entity Type:Individual
Prefix:
First Name:SOHAIB
Middle Name:
Last Name:MANNAN
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 1:6034 HAMILTON BLVD
Mailing Address - Street 2:PO BOX 114
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9788
Mailing Address - Country:US
Mailing Address - Phone:610-904-8100
Mailing Address - Fax:
Practice Address - Street 1:2000 EBERHART RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-3645
Practice Address - Country:US
Practice Address - Phone:610-904-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD478930207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine