Provider Demographics
NPI:1972886018
Name:MANEY, EILEEN M (PA-C)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:M
Last Name:MANEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:GIBBONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 RADNOR RD
Mailing Address - Street 2:STE 101
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7986
Mailing Address - Country:US
Mailing Address - Phone:814-231-7878
Mailing Address - Fax:814-237-1034
Practice Address - Street 1:100 RADNOR RD
Practice Address - Street 2:STE 101
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7986
Practice Address - Country:US
Practice Address - Phone:814-231-7878
Practice Address - Fax:814-237-1034
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055038363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGI228664Medicare PIN