Provider Demographics
NPI:1174515811
Name:MANZETTI, GENE W (MD)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:W
Last Name:MANZETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:850 CLAIRTON BLVD
Mailing Address - Street 2:STE 2300
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236
Mailing Address - Country:US
Mailing Address - Phone:412-469-2700
Mailing Address - Fax:412-466-7010
Practice Address - Street 1:850 CLAIRTON BLVD
Practice Address - Street 2:STE 2300
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236
Practice Address - Country:US
Practice Address - Phone:412-469-2700
Practice Address - Fax:412-466-7010
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD015124E208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008143700001Medicaid
B35495Medicare UPIN
PA091352Medicare ID - Type Unspecified