Provider Demographics
NPI:1740317890
Name:MANGER, DONALD FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:FREDERICK
Last Name:MANGER
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 1:11600 BEDFORD RD NE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6805
Mailing Address - Country:US
Mailing Address - Phone:301-777-9631
Mailing Address - Fax:301-777-8134
Practice Address - Street 1:11600 BEDFORD RD NE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6805
Practice Address - Country:US
Practice Address - Phone:301-777-9631
Practice Address - Fax:301-777-8134
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD009231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
814331OtherMAMSI
256471OtherUHC
MDW034-0001OtherBCBS BLUE CHOICE FED
MDW034-0001OtherBCBS BLUE CHOICE FED
5646DFMedicare ID - Type Unspecified