Basic Information
Provider Information
NPI: 1316266190
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MANKO
FirstName: ADAM
MiddleName: G.
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 700 ACKERMAN RD STE 2120
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432021559
CountryCode: US
TelephoneNumber: 6142934925
FaxNumber:  
Practice Location
Address1: 2050 KENNY RD
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432213502
CountryCode: US
TelephoneNumber: 6142934925
FaxNumber: 6142935503
Other Information
ProviderEnumerationDate: 05/19/2010
LastUpdateDate: 07/02/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001XME126269FLN Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
207RP1001X51574SCN Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
207RP1001X35.121168OHY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


Home