Provider Demographics
NPI:1760567572
Name:MANN, GARY NEIL (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:NEIL
Last Name:MANN
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 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:600 IVY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1627
Practice Address - Country:US
Practice Address - Phone:607-737-7780
Practice Address - Fax:607-737-7788
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038838208600000X, 2086X0206X
TXQ5859208600000X, 2086X0206X
NY286574208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1760567572Medicaid
265110OtherINTERNAL ID-MOTOR VEHICLE ID
NY04588487Medicaid
TX349029401Medicaid
WA0231489OtherL&I
TX349029401Medicaid
NYJ400343926Medicare PIN
WA0231489OtherL&I
WAAB16187Medicare PIN