Provider Demographics
NPI:1992027569
Name:MANZIANO, ROCCO (LAC)
Entity Type:Individual
Prefix:
First Name:ROCCO
Middle Name:
Last Name:MANZIANO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12602 HOLDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3830
Mailing Address - Country:US
Mailing Address - Phone:240-833-8686
Mailing Address - Fax:
Practice Address - Street 1:3200 TOWER OAKS BLVD
Practice Address - Street 2:430
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4216
Practice Address - Country:US
Practice Address - Phone:240-833-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAC041171100000X
NJ25MZ00050500171100000X
MDU01922171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist