Provider Demographics
NPI:1821080979
Name:MANSBERGER, JAMES WARREN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WARREN
Last Name:MANSBERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10663 RAYSTOWN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-7542
Mailing Address - Country:US
Mailing Address - Phone:814-627-0071
Mailing Address - Fax:814-627-0315
Practice Address - Street 1:10663 RAYSTOWN RD
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-7542
Practice Address - Country:US
Practice Address - Phone:814-627-0071
Practice Address - Fax:814-627-0315
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S010062L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001543462OtherBLUE SHIELD
PA0018492240004Medicaid
H35478Medicare UPIN
PA0018492240004Medicaid