Provider Demographics
NPI:1891716403
Name:MANISCALCO, STEPHEN P (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:MANISCALCO
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 1:920 MEDICAL PLAZA DR STE 360
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3271
Mailing Address - Country:US
Mailing Address - Phone:281-803-8482
Mailing Address - Fax:281-803-8432
Practice Address - Street 1:9201 PINECROFT DR
Practice Address - Street 2:SUITE 210
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3222
Practice Address - Country:US
Practice Address - Phone:936-441-1010
Practice Address - Fax:832-442-3081
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1655208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145174205Medicaid
TX145174205Medicaid
TX267655YMCGMedicare PIN
TX8D7186Medicare PIN
TX267655YK26Medicare PIN
P00320653Medicare PIN