Provider Demographics
NPI:1821145749
Name:MANION, DANIEL G (PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:MANION
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2917
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2917
Mailing Address - Country:US
Mailing Address - Phone:606-218-3500
Mailing Address - Fax:
Practice Address - Street 1:1575 SOQUEL DR
Practice Address - Street 2:STE C
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1700
Practice Address - Country:US
Practice Address - Phone:650-934-3546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA52173363A00000X
NC100380363AS0400X
KYPA1570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7901940Medicaid
NC970003664OtherRAILROAD MEDICARE
KY7100123670Medicaid
NC7901940Medicaid
KY7100123670Medicaid
KYP400015651Medicare PIN