Provider Demographics
NPI:1821073388
Name:MANNONE, ANTONINO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONINO
Middle Name:
Last Name:MANNONE
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 1:8201 MAIN STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5934
Mailing Address - Country:US
Mailing Address - Phone:716-632-3577
Mailing Address - Fax:
Practice Address - Street 1:8201 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6046
Practice Address - Country:US
Practice Address - Phone:716-632-3577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159226207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00902098Medicaid
NYB35595Medicare UPIN
NY279801Medicare ID - Type Unspecified