Provider Demographics
NPI:1063482529
Name:MANNING, CHARLES F JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:MANNING
Suffix:JR
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 1:1899 EIDER CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4537
Mailing Address - Country:US
Mailing Address - Phone:850-878-5143
Mailing Address - Fax:850-942-6622
Practice Address - Street 1:1899 EIDER CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4537
Practice Address - Country:US
Practice Address - Phone:850-878-5143
Practice Address - Fax:850-942-6622
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46181207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL220006548OtherRAILROAD MEDICARE
FL37492OtherBCBS INDIVIDUAL ID#
FL0442321Medicaid
FLD54645Medicare UPIN
FL37492ZMedicare ID - Type Unspecified