Individual
MR. ALBERT J. MANVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2331 FRANKLIN RD SW, ROANOKE, VA 24014-1111
(540) 725-1226
(540) 857-5306
Mailing address
2331 FRANKLIN RD SW, ROANOKE, VA 24014-1111
(540) 725-1226
(540) 857-5306
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110-001242
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912971862
MEDICAID QMB
VA
01
—
371194700
BLACK LUNG
VA
01
—
540506332108
TRICARE/CHAMPUS
VA
01
—
P00191374
RAILROAD MEDICARE
VA
Enumeration date
02/16/2006
Last updated
08/25/2016
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