Provider Demographics
NPI:1023084571
Name:MANTER, KRISTEN DENISE (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DENISE
Last Name:MANTER
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:PO BOX 746087
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6087
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:1249 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3844
Practice Address - Country:US
Practice Address - Phone:718-765-6008
Practice Address - Fax:347-682-4219
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
112467268MA01OtherCAREPLUS
PPO5996243OtherGHI
204590101OtherHEALTHPLUS
P3614958OtherOXFORD
40426028484OtherFIDELIS
PC4845OtherCENTERCARE CHP
NY00357451Medicaid
204590101OtherHEALTHPLUS
331818Medicare ID - Type Unspecified
WI331954Medicare Oscar/Certification
WIW6L111Medicare Oscar/Certification
WI331009Medicare Oscar/Certification
WI331946Medicare Oscar/Certification
WI331945Medicare Oscar/Certification
WI331944Medicare Oscar/Certification
P3614958OtherOXFORD
WI331943Medicare Oscar/Certification
WI331058Medicare Oscar/Certification
112467268MA01OtherCAREPLUS
PPO5996243OtherGHI
40426028484OtherFIDELIS
WI331947Medicare Oscar/Certification