Provider Demographics
NPI:1861497026
Name:MANALE, STEPHEN BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BERNARD
Last Name:MANALE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0011
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:1014 WEST ST. CLARE BLVD
Practice Address - Street 2:SUITE 3015
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-2141
Practice Address - Country:US
Practice Address - Phone:225-743-2455
Practice Address - Fax:225-743-2460
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2021-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA200129208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA295073Medicaid
LAH64422Medicare UPIN