Provider Demographics
NPI:1891908422
Name:STEWART CLEAVES MANNING, MD PA
Entity Type:Organization
Organization Name:STEWART CLEAVES MANNING, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:CLEAVES
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-338-2144
Mailing Address - Street 1:1121 N ROAD ST STE A
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3470
Mailing Address - Country:US
Mailing Address - Phone:252-338-2144
Mailing Address - Fax:252-338-2145
Practice Address - Street 1:1121 N ROAD ST STE A
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3470
Practice Address - Country:US
Practice Address - Phone:252-338-2144
Practice Address - Fax:252-338-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38380174400000X, 261QE0700X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6953907Medicaid
2335896OtherMEDICARE PTAN
NCE86661Medicare UPIN