Provider Demographics
NPI:1982713079
Name:MANTING, MICHELE A (MD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:MANTING
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3308
Mailing Address - Country:US
Mailing Address - Phone:508-941-7379
Mailing Address - Fax:508-941-6330
Practice Address - Street 1:680 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:508-941-7379
Practice Address - Fax:508-941-6330
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA257445207VG0400X
FLME 100859207V00000X
TX43775207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110097754AMedicaid
GA16BDTQMMedicare ID - Type UnspecifiedGA MEDICARE #
GA000886597AMedicaid
F64454Medicare UPIN
SCG49243Medicaid