Provider Demographics
NPI:1053340927
Name:MANCHESTER, RALPH A (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:A
Last Name:MANCHESTER
Suffix:
Gender:M
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:POB 270617
Mailing Address - Street 2:738 LIBRARY RD
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14627-0617
Mailing Address - Country:US
Mailing Address - Phone:585-275-2662
Mailing Address - Fax:585-256-1285
Practice Address - Street 1:738 LIBRARY RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14627-0617
Practice Address - Country:US
Practice Address - Phone:585-275-2662
Practice Address - Fax:585-256-1285
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153879-1207R00000X
NY153879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01037925Medicaid
NYB76303Medicare UPIN
NYRB1511Medicare PIN
NYJ400042280Medicare PIN
NYUN17968CMedicare PIN