Provider Demographics
NPI:1851362537
Name:MANNING, AINSLY OLIVER (PA)
Entity Type:Individual
Prefix:
First Name:AINSLY
Middle Name:OLIVER
Last Name:MANNING
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 1:819 WORCESTER ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1045
Mailing Address - Country:US
Mailing Address - Phone:413-543-6820
Mailing Address - Fax:413-543-7962
Practice Address - Street 1:222 STATE ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-3437
Practice Address - Country:US
Practice Address - Phone:413-308-3300
Practice Address - Fax:413-308-3601
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA1161363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008036403Medicaid
P29610Medicare UPIN
CT008036403Medicaid