Provider Demographics
NPI:1053403808
Name:MACHIRAN, MANUEL ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:ANTONIO
Last Name:MACHIRAN
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 1:802 MAPLEHURST LN
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-1433
Mailing Address - Country:US
Mailing Address - Phone:410-329-6027
Mailing Address - Fax:
Practice Address - Street 1:7850 ROSSVILLE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-3934
Practice Address - Country:US
Practice Address - Phone:410-661-9020
Practice Address - Fax:410-661-5587
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD183942080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB70771Medicare UPIN