| Diana M Mancuso Md Pa | |
|
4300 W Main St Suite 16 Dothan AL 36305-1054 | |
| (334) 793-4120 | |
| (334) 615-8443 |
| Full Name | Diana M Mancuso Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 4300 W Main St, Dothan, Alabama |
| Authorized Official Name and Position | Diana M Mancuso (PRESIDENT) |
| Authorized Official Contact | 3347934120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diana M Mancuso Md Pa 4300 W Main St Suite 16 Dothan AL 36305-1054 Ph: (334) 793-4120 | Diana M Mancuso Md Pa 4300 W Main St Suite 16 Dothan AL 36305-1054 Ph: (334) 793-4120 |
| NPI Number | 1366692246 |
|---|---|
| Provider Enumeration Date | 09/26/2008 |
| Last Update Date | 03/09/2009 |
| Medicare PECOS PAC ID | 1052476678 |
|---|---|
| Medicare Enrollment ID | O20090216000210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366692246 | NPI | - | NPPES |
| 000000013 | Other | AL | MEDICARE PROVIDER NUMBER |
| 000000013 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 4436 (Alabama) | Primary |
| Provider Name | Diana M Mancuso |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417971037 PECOS PAC ID: 9234294844 Enrollment ID: I20090216000199 |
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