Provider Demographics
NPI:1194928952
Name:MANZOOR, SYED ZIA (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:ZIA
Last Name:MANZOOR
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-2710
Mailing Address - Fax:717-339-2711
Practice Address - Street 1:40 V TWIN DR
Practice Address - Street 2:STE 202
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7875
Practice Address - Country:US
Practice Address - Phone:717-339-2710
Practice Address - Fax:717-339-2711
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMDMD4337272084P0804X
PAMD4337272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102163554Medicaid
PA126946Medicare PIN