Provider Demographics
NPI:1346464880
Name:GHAFFARI, MANELY (MD)
Entity type:Individual
Prefix:
First Name:MANELY
Middle Name:
Last Name:GHAFFARI
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 1:129 N 4TH ST
Mailing Address - Street 2:OFFICE 1F
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1817
Mailing Address - Country:US
Mailing Address - Phone:267-702-0543
Mailing Address - Fax:
Practice Address - Street 1:129 N 4TH ST
Practice Address - Street 2:OFFICE 1F
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-1817
Practice Address - Country:US
Practice Address - Phone:267-702-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4330272084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry