MANOS, HEATHER MICHELLE (MD)

Provider Demographics

• NPI: 1427186022
• Name: MANOS, HEATHER MICHELLE (MD)
• Entity Type: Individual
• Prefix: DR
• First Name: HEATHER
• Middle Name: MICHELLE
• Last Name: MANOS
• Gender: F
• Credentials: MD
• Mailing Address - Street 1: 1200 MYRTLE AVE
• Mailing Address - City: CHARLOTTE
• Mailing Address - State: NC
• Mailing Address - Zip Code: 28203-4540
• Mailing Address - Country: US
• Mailing Address - Phone: 704-995-1992
• Practice Address - Street 1: 6010 E WT HARRIS BLVD
• Practice Address - City: CHARLOTTE
• Practice Address - State: NC
• Practice Address - Zip Code: 28215-4084
• Practice Address - Country: US
• Practice Address - Phone: 704-208-4134
• Practice Address - Fax: 704-248-8068
• Is Sole Proprietor?: No
• Enumeration Date: 2007-03-02
• Last Update Date: 2023-03-07

Provider Licenses

State	License ID	Taxonomies
NC	2009-01740	207Q00000X, 207QA0401X, 207QA0401X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	207QA0401X	Allopathic & Osteopathic Physicians	Family Medicine	Addiction Medicine
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	AC5385578R124	Other	DEA
NC	1427186022	Medicaid
NC	AC5385578R124	Other	DEA
NC	2077063	Medicare PIN
NC	2077063E	Medicare PIN
NC	2077063J	Medicare PIN
NC	2077156	Medicare PIN
NC	2077063A	Medicare PIN
NC	AC5385578R124	Other	DEA
NC	2077063K	Medicare PIN
NC	2077063L	Medicare PIN
NC	NCC316A	Medicare PIN
NC	2077063C	Medicare PIN
NC	2077063D	Medicare PIN
NC	2077063S	Medicare PIN
NC	5914077	Medicaid
NC	2077063U	Medicare PIN
NC	2077063W	Medicare PIN
NC	2077063B	Medicare PIN
NC	2077063M	Medicare PIN
NC	2077063R	Medicare PIN
NC	2077063G	Medicare PIN
NC	2077063I	Medicare PIN
NC	2077063O	Medicare PIN
NC	2077063P	Medicare PIN
NC	2077063T	Medicare PIN
NC	2077063V	Medicare PIN
NC	2077063X	Medicare PIN
NC	2077063Y	Medicare PIN
NC	2077063Z	Medicare PIN
NC	2077063H	Medicare PIN