Provider Demographics
NPI:1043842529
Name:ROVIRA GONZALEZ, MANUEL JOSE (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:JOSE
Last Name:ROVIRA GONZALEZ
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 1:2092 W PENN PIKE
Mailing Address - Street 2:
Mailing Address - City:NEW RINGGOLD
Mailing Address - State:PA
Mailing Address - Zip Code:17960-9398
Mailing Address - Country:US
Mailing Address - Phone:272-639-5370
Mailing Address - Fax:
Practice Address - Street 1:2092 W PENN PIKE
Practice Address - Street 2:
Practice Address - City:NEW RINGGOLD
Practice Address - State:PA
Practice Address - Zip Code:17960-9398
Practice Address - Country:US
Practice Address - Phone:272-639-5370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD490593207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD490593Medicaid