Provider Demographics
NPI:1942235650
Name:MANTON, MARY A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:A
Last Name:MANTON
Suffix:
Gender:F
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:UCONN STUDENT HEALTH SERVICES
Mailing Address - Street 2:234 GLENBROOK ROAD
Mailing Address - City:STORRS MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06269-0001
Mailing Address - Country:US
Mailing Address - Phone:860-486-0748
Mailing Address - Fax:860-486-1597
Practice Address - Street 1:UCONN STUDENT HEALTH SERVICES
Practice Address - Street 2:234 GLENBROOK ROAD
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06269-0001
Practice Address - Country:US
Practice Address - Phone:860-486-0748
Practice Address - Fax:860-486-1597
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine