Basic Information
| Provider Information | |||||||||
| NPI: | 1578765301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANOLAS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 241 S 6TH ST | ||||||||
| Address2: | SUITE 1303 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191063727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2672538721 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2301 COLUMBIA AVE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176034154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173972738 | ||||||||
| FaxNumber: | 7173977634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT184069 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.