Basic Information
| Provider Information | |||||||||
| NPI: | 1508895178 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANTIONE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8105 ADAMS DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | HUMMELSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170368625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7174828115 | ||||||||
| FaxNumber: | 7174828364 | ||||||||
| Practice Location | |||||||||
| Address1: | 8105 ADAMS DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | HUMMELSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170368625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7174828115 | ||||||||
| FaxNumber: | 7174828364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD070704L | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.