Provider Demographics
NPI:1245624345
Name:MANUKIAN, GREGOR (MD, PHD)
Entity type:Individual
Prefix:
First Name:GREGOR
Middle Name:
Last Name:MANUKIAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-2143
Mailing Address - Country:US
Mailing Address - Phone:484-628-8067
Mailing Address - Fax:215-955-0412
Practice Address - Street 1:111 S. 11TH STREET
Practice Address - Street 2:BODINE CENTER G301
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-5669
Practice Address - Fax:215-955-0412
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4705052085R0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program