Provider Demographics
NPI:1962487264
Name:MANZELLA, EDWARD D (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:D
Last Name:MANZELLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 110B
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:1353 STATE ROUTE 903
Practice Address - Street 2:
Practice Address - City:JIM THORPE
Practice Address - State:PA
Practice Address - Zip Code:18229-2734
Practice Address - Country:US
Practice Address - Phone:570-325-8393
Practice Address - Fax:570-325-8029
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2023-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD047252L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2420346000OtherPERSONAL CHOICE BLUE SHIE
03277901OtherCAPITAL BLUE CROSS
1753980OtherFEDERAL BLUE SHIELD
810651818OtherCOVENTRY HEALTH
110101OtherAMERIHEALTH ADMIN
810651818OtherTRICARE REGION I
03277800OtherCAPITAL BLUE CROSS GROUP
PAP00387554OtherPALMETTO GBA GROUP
PA001442722Medicaid
20031254OtherAMERIHEALTH MERCY
810651818OtherSTERLING OPTION I GROUP
1753980OtherAMERIHEALTH ADMIN GROUP
010654900OtherBLACK LUNG
110101OtherPA BLUE SHIELD
5389099OtherAETNA
6002088OtherGHI
0274540000OtherPERSONAL CHOICE BLUE SHIE