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NPI Code Detail

MEDICARE: PETER G MANOS MD LLC

MEDICARE: PETER G MANOS MD LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianSC4107SC

General Provider Information

NPI Number : 1811170178
Entity Type Code : Organization
Provider Name (Legal Business Name) : PETER G MANOS MD LLC
Provider Business Mailing Address
First Line : 10 ENTERPRISE BLVD STE 207
Second Line :
City : GREENVILLE
State : SC
Zip : 29615-3554
Country : US
Telephone Number : 864-458-8980
Fax Number : 864-458-8984
Provider Business Practice Location Address
First Line : 10 ENTERPRISE BLVD STE 207
Second Line :
City : GREENVILLE
State : SC
Zip : 29615-3554
Country : US
Telephone Number : 864-458-8980
Fax Number : 864-458-8984
Authorized Official
Title or Position : PRACTICE MANAGER
Name : MS. LEE ANN VIEIRA
Credential :
Telephone Number : 864-458-8980
Provider Enumeration Date : 12/10/2007
Last Update Date : 12/11/2007

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Directions to “PETER G MANOS MD LLC ” Practice Location

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