Provider Demographics
NPI:1770710683
Name:MANOS, KATRINA JEANNE (DPM)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:JEANNE
Last Name:MANOS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MISS
Other - First Name:KATRINA
Other - Middle Name:JEANNE
Other - Last Name:HALLAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2236 RIDGE RD. W
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2804
Mailing Address - Country:US
Mailing Address - Phone:585-225-2290
Mailing Address - Fax:585-225-1367
Practice Address - Street 1:2236 RIDGE RD W.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2804
Practice Address - Country:US
Practice Address - Phone:585-225-2290
Practice Address - Fax:585-225-1367
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1235213ES0103X
NY006474213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery