Basic Information
| Provider Information | |||||||||
| NPI: | 1962588897 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANN | ||||||||
| FirstName: | BRIAN | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 843298 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022843298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102155100 | ||||||||
| FaxNumber: | 9102155114 | ||||||||
| Practice Location | |||||||||
| Address1: | 7473 C HWY 22 | ||||||||
| Address2: | |||||||||
| City: | WHISPERING PINES | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283270000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102155100 | ||||||||
| FaxNumber: | 9102155114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 10/06/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 50001829 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 11548 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.