Provider Demographics
NPI:1750348116
Name:MANNARI, CHRISTOPHER JOHN (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:MANNARI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:HEALTH ACCESS NETWORK INC
Mailing Address - City:LEE
Mailing Address - State:ME
Mailing Address - Zip Code:04455-0026
Mailing Address - Country:US
Mailing Address - Phone:207-738-2209
Mailing Address - Fax:
Practice Address - Street 1:175 WEST BROADWAY
Practice Address - Street 2:HEALTH ACCESS NETWORK INC,
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-0099
Practice Address - Country:US
Practice Address - Phone:207-794-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103682363A00000X
MEPA001241363A00000X
MEPA315363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMM2265963OtherDEA