Provider Demographics
NPI:1265415152
Name:RATHER, MANZOOR (MD)
Entity type:Individual
Prefix:
First Name:MANZOOR
Middle Name:
Last Name:RATHER
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 1:1 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2007
Mailing Address - Country:US
Mailing Address - Phone:610-567-6964
Mailing Address - Fax:610-567-6170
Practice Address - Street 1:1500 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1200
Practice Address - Country:US
Practice Address - Phone:610-237-3698
Practice Address - Fax:610-237-2580
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066183207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017513160003Medicaid
PA1662167OtherCIGNA
PA323265000OtherKEYSTONE HEALTH PLAN EAST
PA402279OtherBLUE SHIELD
PA2370227OtherAETNA
PA1108918OtherKMHP
PA1108918OtherKMHP
PA2370227OtherAETNA