Provider Demographics
NPI:1700893229
Name:MANARA, LOUIS R (DO)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:R
Last Name:MANARA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 A RT. 73 N
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2601
Mailing Address - Country:US
Mailing Address - Phone:856-767-0009
Mailing Address - Fax:856-767-0009
Practice Address - Street 1:200 A RT. 73 N
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2601
Practice Address - Country:US
Practice Address - Phone:856-767-0009
Practice Address - Fax:856-767-0009
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB033420207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C52404Medicare UPIN
NJ004214Medicare ID - Type Unspecified