Provider Demographics
NPI:1710621297
Name:MANIACI, JOSEPH LAWRENCE
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LAWRENCE
Last Name:MANIACI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BRINKHOUS-BULLITT BLDG CB#7525
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7525
Mailing Address - Country:US
Mailing Address - Phone:919-966-4676
Mailing Address - Fax:919-966-6718
Practice Address - Street 1:300 BRINKHOUS-BULLITT BLDG CB#7525
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-5022
Practice Address - Country:US
Practice Address - Phone:919-966-4676
Practice Address - Fax:919-966-6718
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRTL22-0085390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program