Provider Demographics
NPI:1568565760
Name:MANIET, ALAN RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:RICHARD
Last Name:MANIET
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1134 N ROAD ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3365
Mailing Address - Country:US
Mailing Address - Phone:252-331-1100
Mailing Address - Fax:252-338-9170
Practice Address - Street 1:1134 N ROAD ST
Practice Address - Street 2:SUITE 9
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3365
Practice Address - Country:US
Practice Address - Phone:252-331-1100
Practice Address - Fax:252-338-9170
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2000151772207RC0000X
NC200301381207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease