Basic Information
| Provider Information | |||||||||
| NPI: | 1164959656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANUELE | ||||||||
| FirstName: | ANGELO | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 W 27TH ST | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283583075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106715000 | ||||||||
| FaxNumber: | 9102727153 | ||||||||
| Practice Location | |||||||||
| Address1: | 730 OAKRIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283582324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107382662 | ||||||||
| FaxNumber: | 9102727153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2017 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34.014389 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.