Provider Demographics
NPI:1780122424
Name:MANN, DOUGLAS (ATC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:MANN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MULLICA HILL RD
Mailing Address - Street 2:ROWAN UNIVERSITY
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1700
Mailing Address - Country:US
Mailing Address - Phone:856-256-4500
Mailing Address - Fax:
Practice Address - Street 1:201 MULLICA HILL RD
Practice Address - Street 2:ROWAN UNIVERSITY
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1700
Practice Address - Country:US
Practice Address - Phone:856-256-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00088200405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional