Provider Demographics
NPI:1457426611
Name:THOMAS L. MANZO, M.D., P.C.
Entity Type:Organization
Organization Name:THOMAS L. MANZO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-326-4044
Mailing Address - Street 1:1329 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-4949
Mailing Address - Country:US
Mailing Address - Phone:610-326-4044
Mailing Address - Fax:610-326-6901
Practice Address - Street 1:1329 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-4949
Practice Address - Country:US
Practice Address - Phone:610-326-4044
Practice Address - Fax:610-326-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-016446-E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28420Medicare UPIN
120513Medicare PIN