Provider Demographics
NPI:1689665127
Name:MANUS, ROSELYN ABALOS (MD)
Entity Type:Individual
Prefix:
First Name:ROSELYN
Middle Name:ABALOS
Last Name:MANUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3546 CHANTICLEER CT
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8190
Mailing Address - Country:US
Mailing Address - Phone:330-320-0145
Mailing Address - Fax:
Practice Address - Street 1:822 KUMHO DR
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9297
Practice Address - Country:US
Practice Address - Phone:330-576-0500
Practice Address - Fax:330-576-0467
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078493207R00000X
OH35-078493208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341960347OtherSUMMA
OH23955OtherQUALCHOICE
OH2191640Medicaid
OH341960347DOtherAULTCARE
OH7120189OtherAETNA
OH11682367300OtherBWC
OH05200OtherKAISER PERMANENTE
OH5628939OtherFIRST HEALTH NETWORK
OH000000342548OtherANTHEM
OHP00173247Medicare PIN
OH11682367300OtherBWC
OH7120189OtherAETNA
341960347Medicare PIN
OH341960347DOtherAULTCARE