Basic Information
Provider Information
NPI: 1720277353
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MANULI
FirstName: MARGERY
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 100374
Address2:  
City: GAINESVILLE
State: FL
PostalCode: 326100374
CountryCode: US
TelephoneNumber: 3522650291
FaxNumber: 3522650279
Practice Location
Address1: 1600 SW ARCHER RD
Address2:  
City: GAINESVILLE
State: FL
PostalCode: 326104007
CountryCode: US
TelephoneNumber: 3522650291
FaxNumber: 3522650279
Other Information
ProviderEnumerationDate: 10/19/2007
LastUpdateDate: 03/03/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/03/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X0101055439VAN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085P0229X0101055439VAN Allopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
2085R0202XME145205FLY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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