Basic Information
| Provider Information | |||||||||
| NPI: | 1548375819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANCANO | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 BERNVILLE RD | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196059453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103782440 | ||||||||
| FaxNumber: | 6103782441 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 BERNVILLE RD | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196059453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103782000 | ||||||||
| FaxNumber: | 6103782799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 02/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD041687E | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 001257519 | 05 | PA | MEDICAID |