Provider Demographics
NPI:1558382408
Name:MANTEL, NICHOLAS MORGAN (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MORGAN
Last Name:MANTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:804 SCOTT NIXON MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2464
Mailing Address - Country:US
Mailing Address - Phone:800-394-4445
Mailing Address - Fax:706-650-1034
Practice Address - Street 1:201 E UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2829
Practice Address - Country:US
Practice Address - Phone:410-554-2323
Practice Address - Fax:410-554-6764
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-12-03
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Provider Licenses
StateLicense IDTaxonomies
MDD64074207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKQ83Q446Medicare PIN