Provider Demographics
NPI:1205810876
Name:MANZELLA, VICTOR A (MD)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:A
Last Name:MANZELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
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:2005-12-06
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063778L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
03180401OtherCAPITAL BLUE CROSS
PA034162OtherBLUE SHIELD
0444184000OtherPERSONAL BLUE SHIELD
2598929OtherGHI
5389099OtherAETNA
1753980OtherFEDERAL BLUE SHIELD
P00416365OtherPALMETTO GBA GROUP
010044500OtherBLACK LUNG
034162OtherAMERIHEALTH ADMIN
20031256OtherAMERIHEALTH MERCY
PA034162OtherBLUE SHIELD
20031256OtherAMERIHEALTH MERCY
PA876162Medicare ID - Type Unspecified