Provider Demographics
NPI:1316982242
Name:MANKA, MAYA JANE (MD)
Entity type:Individual
Prefix:DR
First Name:MAYA
Middle Name:JANE
Last Name:MANKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 VILLA RD
Mailing Address - Street 2:#116
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1830
Mailing Address - Country:US
Mailing Address - Phone:503-538-7407
Mailing Address - Fax:503-537-0640
Practice Address - Street 1:308 VILLA RD
Practice Address - Street 2:#116
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1830
Practice Address - Country:US
Practice Address - Phone:503-538-7407
Practice Address - Fax:503-537-0640
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10760174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR126565Medicaid
ORF70704Medicare UPIN
OR126565Medicaid