Individual
DR. DOMENIC MICHAEL MANTELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 VILLAGE RUN RD, SUITE 308, WEXFORD, PA 15090-6316
(724) 934-1900
Mailing address
1500 VILLAGE RUN RD, SUITE 308, WEXFORD, PA 15090-6316
(724) 934-1900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD439686
PA
207QS0010X
Sports Medicine (Family Medicine) Physician
MD439686
PA
Other
Enumeration date
05/20/2009
Last updated
02/21/2013
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