Provider Demographics
NPI:1972588325
Name:MANOS, ANTONINUS JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTONINUS
Middle Name:JOSEPH
Last Name:MANOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:905 TRAIL RUN LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-1831
Mailing Address - Country:US
Mailing Address - Phone:610-431-1040
Mailing Address - Fax:
Practice Address - Street 1:915 OLD FERN HILL RD
Practice Address - Street 2:BUILDING D SUITE 500
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4269
Practice Address - Country:US
Practice Address - Phone:610-235-4100
Practice Address - Fax:610-234-4107
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006148L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA078588Medicare PIN
PA551292SPXMedicare PIN
PAF15329Medicare UPIN