Provider Demographics
NPI:1134231640
Name:MANCHIN, JOHN II (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MANCHIN
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26571
Mailing Address - Country:US
Mailing Address - Phone:304-825-6554
Mailing Address - Fax:304-825-1371
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:WV
Practice Address - Zip Code:26571
Practice Address - Country:US
Practice Address - Phone:304-825-6554
Practice Address - Fax:304-825-1371
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0049400000Medicaid
WV0034619000Medicaid
WV0034619000Medicaid
WV0461443Medicare PIN
9916641Medicare PIN