Provider Demographics
NPI:1780685677
Name:MANNION, JOHN DANA (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DANA
Last Name:MANNION
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 1:704 GREEN WINGED TRL
Mailing Address - Street 2:
Mailing Address - City:CAMDEN WYOMING
Mailing Address - State:DE
Mailing Address - Zip Code:19934-9530
Mailing Address - Country:US
Mailing Address - Phone:302-697-1377
Mailing Address - Fax:
Practice Address - Street 1:540 S GOVERNORS AVE
Practice Address - Street 2:SUITE 101A
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3530
Practice Address - Country:US
Practice Address - Phone:302-744-7980
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007255208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000032313Medicaid
C32989Medicare UPIN
DE1000032313Medicaid