Provider Demographics
NPI:1679533327
Name:CORNEL-MANALOTO, MANOLISA TANDOC (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOLISA
Middle Name:TANDOC
Last Name:CORNEL-MANALOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MANOLISA
Other - Middle Name:TANDOC
Other - Last Name:CORNEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-26
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH17373Medicare UPIN
VA00W203M01Medicare PIN