Provider Demographics
NPI:1205924198
Name:MANSKER, DEANNA ROCHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:ROCHELLE
Last Name:MANSKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SOLOMON CT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6825
Mailing Address - Country:US
Mailing Address - Phone:843-830-3486
Mailing Address - Fax:
Practice Address - Street 1:96 JONATHAN LUCAS ST
Practice Address - Street 2:MUSC DEPARTMENT OF SURGERY
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8900
Practice Address - Country:US
Practice Address - Phone:843-792-3072
Practice Address - Fax:843-792-8286
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL28917208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery