Provider Demographics
NPI:1295785277
Name:MANNING, AMY FLATT (PAC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:FLATT
Last Name:MANNING
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:GAYLE
Other - Last Name:FLATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 CHAPEL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:REINHOLDS
Mailing Address - State:PA
Mailing Address - Zip Code:17569-9506
Mailing Address - Country:US
Mailing Address - Phone:717-341-3400
Mailing Address - Fax:
Practice Address - Street 1:25 CHAPEL VIEW DR
Practice Address - Street 2:
Practice Address - City:REINHOLDS
Practice Address - State:PA
Practice Address - Zip Code:17569-9506
Practice Address - Country:US
Practice Address - Phone:717-341-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002030L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1594327OtherGATEWAY MEDICARE ASSURED
PA2686180OtherHIGHMARK BLUE SHIELD - FREEDOM BLUE
S55720Medicare UPIN
PA2686180OtherHIGHMARK BLUE SHIELD - FREEDOM BLUE
PA1594327OtherGATEWAY MEDICARE ASSURED