Provider Demographics
NPI:1255348025
Name:MANCHER, KENNETH ELI (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ELI
Last Name:MANCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WESTERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-3320
Mailing Address - Country:US
Mailing Address - Phone:203-881-0400
Mailing Address - Fax:203-881-2708
Practice Address - Street 1:17 WESTERMAN AVE
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-3320
Practice Address - Country:US
Practice Address - Phone:203-881-0400
Practice Address - Fax:203-881-2708
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025678207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001256783Medicaid
CT0796894OtherCIGNA
CT001070OtherHEALTHNET
CT010025678OtherANTHEM
CTP402416OtherOXFORD
CT759954OtherCONNECTICARE
CTP402416OtherOXFORD
CTB83311Medicare UPIN