Provider Demographics
NPI:1609850403
Name:MANSHIP, MARK EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:MANSHIP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1366 N GARDNER ST
Mailing Address - Street 2:STE 140
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170
Mailing Address - Country:US
Mailing Address - Phone:812-752-7444
Mailing Address - Fax:812-752-6855
Practice Address - Street 1:1366 N GARDNER ST
Practice Address - Street 2:STE 140
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170
Practice Address - Country:US
Practice Address - Phone:812-752-7444
Practice Address - Fax:812-752-6855
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01028150A207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100331030Medicaid
IN000000295943OtherANTHEM BCBS
IN205950AMedicare ID - Type Unspecified
IN100331030Medicaid