Provider Demographics
NPI:1760402333
Name:MANFREDI, ROCCO LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROCCO
Middle Name:LOUIS
Last Name:MANFREDI
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 1:145 POLO RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311-9745
Mailing Address - Country:US
Mailing Address - Phone:610-268-2514
Mailing Address - Fax:
Practice Address - Street 1:5A MEL RON CT
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-8414
Practice Address - Country:US
Practice Address - Phone:717-730-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031899E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB40037Medicare UPIN
PA153319Medicare ID - Type Unspecified