Provider Demographics
NPI:1932162120
Name:MANITIUS, EVA M (MD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:M
Last Name:MANITIUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10831 FOREST PINES DR STE 110
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8077
Mailing Address - Country:US
Mailing Address - Phone:919-570-9090
Mailing Address - Fax:919-570-9043
Practice Address - Street 1:10831 FOREST PINES DR STE 110
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8077
Practice Address - Country:US
Practice Address - Phone:919-570-9090
Practice Address - Fax:919-570-9043
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-09
Last Update Date:2019-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9400914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2203290BMedicare PIN
NCF90662Medicare UPIN