Provider Demographics
NPI:1235333584
Name:MANULI INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:MANULI INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MANULI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-338-5183
Mailing Address - Street 1:104 MILL END CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-8986
Mailing Address - Country:US
Mailing Address - Phone:252-338-5183
Mailing Address - Fax:252-338-5669
Practice Address - Street 1:104 MILL END CT
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-8986
Practice Address - Country:US
Practice Address - Phone:252-338-5183
Practice Address - Fax:252-338-5669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601393207R00000X
NC182382207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2348601Medicare ID - Type Unspecified