Provider Demographics
NPI:1699529057
Name:MANIYAR, PANKTI DHARMENDRA
Entity type:Individual
Prefix:
First Name:PANKTI DHARMENDRA
Middle Name:
Last Name:MANIYAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST MARY MEDICAL CENTER, GRADUATE MEDICAL EDUCATION OFFI
Mailing Address - Street 2:1201 LANGHORNE-NEWTON ROAD
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047
Mailing Address - Country:US
Mailing Address - Phone:215-710-6600
Mailing Address - Fax:215-710-5975
Practice Address - Street 1:ST MARY MEDICAL CENTER, GRADUATE MEDICAL EDUCATION OFFI
Practice Address - Street 2:1201 LANGHORNE-NEWTON ROAD
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-710-6600
Practice Address - Fax:215-710-5975
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program