Provider Demographics
NPI:1558304097
Name:MCMANUS, MARK WARREN (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:WARREN
Last Name:MCMANUS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:201 ERVIN RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-2511
Mailing Address - Country:US
Mailing Address - Phone:828-438-1169
Mailing Address - Fax:
Practice Address - Street 1:6336 US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-7141
Practice Address - Country:US
Practice Address - Phone:828-430-9004
Practice Address - Fax:828-430-9444
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2023-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC33273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC57849OtherBLUE CROSS BLUE SHIELD
NC8957849Medicaid
NCE75582Medicare UPIN
NC8957849Medicaid