Provider Demographics
NPI:1376591636
Name:MANZO, MATTHEW T (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:T
Last Name:MANZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 AVIEMORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374
Mailing Address - Country:US
Mailing Address - Phone:910-215-5555
Mailing Address - Fax:910-215-6134
Practice Address - Street 1:10 AVIEMORE DRIVE
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-215-5555
Practice Address - Fax:910-215-0366
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2182209DOtherMEDICARE
NC53849OtherBCBS INDIVIDUAL
NC8953849Medicaid
NCE91315Medicare UPIN