Basic Information
| Provider Information | |||||||||
| NPI: | 1588892616 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANN | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 167 ASHLEY AVE | ||||||||
| Address2: | SUITE 301, MSC 912 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294259120 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 167 ASHLEY AVE | ||||||||
| Address2: | SUITE 301, MSC 912 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294259120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437922322 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2009 | ||||||||
| LastUpdateDate: | 06/26/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | LL1275 | SC | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.