Provider Demographics
NPI:1740223015
Name:MANION, KERNAN THOMAS (MD)
Entity type:Individual
Prefix:
First Name:KERNAN
Middle Name:THOMAS
Last Name:MANION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3415 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4117
Mailing Address - Country:US
Mailing Address - Phone:910-350-8300
Mailing Address - Fax:978-428-4659
Practice Address - Street 1:3415 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4117
Practice Address - Country:US
Practice Address - Phone:910-350-8300
Practice Address - Fax:978-428-4659
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B97284Medicare UPIN