Basic Information
| Provider Information | |||||||||
| NPI: | 1467892794 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANNAN | ||||||||
| FirstName: | SUNJAY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 20826 ROUTE 19 | ||||||||
| Address2: | |||||||||
| City: | CRANBERRY TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160666028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247764776 | ||||||||
| FaxNumber: | 7247760251 | ||||||||
| Practice Location | |||||||||
| Address1: | 20826 ROUTE 19 | ||||||||
| Address2: | |||||||||
| City: | CRANBERRY TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247764776 | ||||||||
| FaxNumber: | 7247760251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2013 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 27112 | WV | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | MD458000 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 103213230 | 05 | PA | MEDICAID |