DR. ANDREA RENATE MANZO (NPI# 1669545679) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669545679 |
| Entity Type | Individual |
| Full Name | DR. ANDREA RENATE MANZO |
| Credential | MD |
| Practice Address |
1304 Fawcett Ave Ste 100 Tacoma WA 98402-1900 |
| Mailing Address |
Po Box 1535 Tacoma WA 98401-1535 |
| Practice Telephone | 2537614200 |
| Practice Fax Number | 2537614201 |
| Mailing Telephone | 2537614200 |
| Mailing Fax Number | 2533833553 |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2018-12-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085B0100X |
Radiology Specialization: Body Imaging |
MD00043385 | WA | Allopathic & Osteopathic Physicians |
| N | 2085B0100X |
Radiology Specialization: Body Imaging |
MD164757 | OR | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
MD164757 | OR | Allopathic & Osteopathic Physicians |
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
MD00043385 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | MEDICARE PIN TRA KING COUNTY | 8803056 | 01 |
| WA | LABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST | 8951848 | 01 |
| OR | 500671257 | 05 | |
| WA | LABOR AND INDUSTRIES/WC UNION AVENUE OPEN | 184431 | 01 |
| WA | PTAN-CMBC | G8878588 | 01 |
| WA | PTAN-MIO1 | G8882929 | 01 |
| WA | LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST | 0249528 | 01 |
| WA | REGENCE BLUE SHIELD TRA | 3231MA | 01 |
| WA | LABOR AND INDUSTRIES CRIME VICTIMS-CAROL MILGARD BREAST CENTER | 8949635 | 01 |
| WA | PTAN-UAOM | G8927637 | 01 |
| WA | RR MEDICARE-CAROL MILGARD BREAST CENTER | P00689845 | 01 |
| WA | LABOR AND INDUSTRIES-CAROL MILGARD BREAST CENTER | 0243528 | 01 |
| WA | LABOR AND INDUSTRIES/WC TRA | 184430 | 01 |
| WA | REGENCE BLUE SHIELD UNION AVENUE OPEN | 7251MA | 01 |
| WA | PTAN-WESTERN STATE HOSPITAL | G8803535 | 01 |
| WA | 8411456 | 05 |
| Street Address |
1304 FAWCETT AVE STE 100 |
| City | TACOMA |
| State | WA |
| Zip Code | 98402-1900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598746232 | Joon Kyung Song | Radiology | 1304 Fawcett Ave Ste 100, Tacoma, WA 98402-1900 | 2005-11-09 |
| 1487179404 | Trevor Lee Reeves | Physician Assistant | 1304 Fawcett Ave Ste 100, Tacoma, WA 98402-1900 | 2017-08-10 |
| 1699228536 | Bridget Ann Lonergan | Registered Nurse | 1304 Fawcett Ave Ste 100, Tacoma, WA 98402-1900 | 2016-07-27 |
| 1508213042 | Amanda Maureen Brown | Physician Assistant | 1304 Fawcett Ave Ste 100, Tacoma, WA 98402-1900 | 2016-05-14 |
| 1841658598 | Gensuke Akaike | Radiology | 1304 Fawcett Ave Ste 100, Tacoma, WA 98402-1900 | 2016-02-09 |
| 1437577723 | Daniel Van Roekel | Radiology | 1304 Fawcett Ave Ste 100, Tacoma, WA 98402-1900 | 2014-04-03 |
| 1912325473 | Nicholas Zane Conley | Radiology | 1304 Fawcett Ave Ste 100, Tacoma, WA 98402-1900 | 2014-04-02 |
| 1619395100 | Sandhya Jacob | Radiology | 1304 Fawcett Ave Ste 100, Tacoma, WA 98402-1900 | 2014-04-01 |
| 1285060426 | Christopher James Schaller | Physician Assistant | 1304 Fawcett Ave Ste 100, Tacoma, WA 98402-1900 | 2013-09-19 |
| 1841553088 | Mark Aaron Broadbent | Radiology | 1304 Fawcett Ave Ste 100, Tacoma, WA 98402 | 2012-06-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548898638 | Cimberleigh Mclean | Social Worker | 2367 Tacoma Ave S Ofc 211, Tacoma, WA 98402 | 2020-04-01 |
| 1831735802 | Nickolas Justin Wise | Case Manager/Care Coordinator | 1159 Market St, Tacoma, WA 98402 | 2019-11-25 |
| 1841835436 | Michael Roy Bolden | Counselor | 1205 Tacoma Ave S., Suite 1205, Tacoma, WA 98402 | 2019-11-07 |
| 1073024980 | Megan Elizabeth Charron Mourfield | Denturist | 725 St Helens Ave S, Tacoma, WA 98402 | 2017-10-18 |
| 1104367937 | Janelle Santiago | Counselor | Mcdonald Smith Building 110, Uw Autism Center Tacoma, Tacoma, WA 98402 | 2017-03-13 |
| 1891167862 | Tanya Larson Therapy | Community/Behavioral Health | 1102 A. St., Suite 109, (suite 109), Tacoma, WA 98402 | 2015-10-29 |
| 1609242148 | Ashley Lorraine Dahlgren | Peer Specialist | 702 S 14th St., Tacoma, WA 98402 | 2015-08-19 |
| 1821416470 | Nicole Villarreal Mccormick | Acupuncturist | 711 A Ct #100, Tacoma, WA 98402 | 2014-04-01 |
| 1184055824 | Robyn Marie Callahan | Social Worker | 1102 A Street, Suite 202 B, Tacoma, WA 98402 | 2013-12-05 |
| 1679909410 | Kristin Sweet Fischer | Counselor | 708 Market St Unit 411, Tacoma, WA 98402 | 2013-09-25 |
| Find all providers in zip 98402 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992001820 | Milton Bleiweiss | Radiology | 3110 N Narrows Dr, Tacoma, WA 98407-1516 | 2011-02-10 |
| 1144480245 | Brian Michael Boldt | Radiology | Madigan Army Medical Ctr Department Of, 9040 Fitzsimmons Drive, Tacoma, WA 98431-0001 | 2008-06-11 |
| 1790986461 | Amy Guttmann | Radiology | 1201 Pacific Ave Ste 400, Tacoma, WA 98402-4381 | 2007-05-30 |
| 1316039985 | Jill D Robinson | Radiology | 2326 Browns Point Blvd Ne, Tacoma, WA 98422-2314 | 2006-09-29 |
| 1225065162 | James Hwiyoung Chang | Radiology | 9040 Jackson Ave Madigan Amc, Tacoma, WA 98431-2010 | 2006-06-27 |
| 1881642668 | Alexander Serra | Radiology | 5426 Hyada Blvd Ne, Tacoma, WA 98422-1620 | 2006-05-04 |
| 1992703474 | James A. Nudelman | Radiology | 1304 Fawcett Ave, Suite 100, Tacoma, WA 98402-1911 | 2005-07-08 |
| 1841658598 | Gensuke Akaike | Radiology | 1304 Fawcett Ave Ste 100, Tacoma, WA 98402-1900 | 2016-02-09 |
| 1194115626 | Matthew Grant | Radiology | 9040 Jackson Ave, Tacoma, WA 98431-1000 | 2015-02-04 |
| 1487073979 | Bryce Allen Merritt | Radiology | 1304 Fawcett Ave, Tacoma, WA 98402-1911 | 2014-04-10 |
| Find all providers in TACOMA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.