Provider Demographics
NPI:1255751707
Name:TERESA MANN, M.D., P.C.
Entity type:Organization
Organization Name:TERESA MANN, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-586-7873
Mailing Address - Street 1:2233 W KAGY BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-5938
Mailing Address - Country:US
Mailing Address - Phone:406-586-7873
Mailing Address - Fax:406-586-2332
Practice Address - Street 1:2233 W KAGY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5938
Practice Address - Country:US
Practice Address - Phone:406-586-7873
Practice Address - Fax:406-586-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty