Provider Demographics
NPI:1104084144
Name:MANTINE, LAURA M (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:MANTINE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:131 PLEASANT DR
Mailing Address - Street 2:SUITE I
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-1384
Mailing Address - Country:US
Mailing Address - Phone:724-379-5400
Mailing Address - Fax:724-302-2091
Practice Address - Street 1:4815 LIBERTY AVE
Practice Address - Street 2:SUITE GR-30
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-621-3844
Practice Address - Fax:412-683-8560
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2014-02-06
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Provider Licenses
StateLicense IDTaxonomies
PAMD432550207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022060430001Medicaid
PA132442KK2Medicare PIN