Provider Demographics
NPI:1063401743
Name:MANHOFF, DION (MD)
Entity type:Individual
Prefix:
First Name:DION
Middle Name:
Last Name:MANHOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:5426 BEAUMONT CENTER BLVD STE 350
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5235
Practice Address - Country:US
Practice Address - Phone:813-286-0033
Practice Address - Fax:813-282-1806
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046725L207ZP0102X
NJ25MA06129300207ZP0102X
FLME136304207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1466985Medicaid
NJ7308604Medicaid
PA1466985Medicaid
NJ7308604Medicaid
NJ790455Medicare ID - Type Unspecified