Healthcare Provider Details

I. General information

NPI: 1750336343
Provider Name (Legal Business Name): GARY MANILOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 RANDOLPH RD STE 600
CHARLOTTE NC
28207-1198
US

IV. Provider business mailing address

1918 RANDOLPH RD STE 600
CHARLOTTE NC
28207-1198
US

V. Phone/Fax

Practice location:
  • Phone: 704-342-0252
  • Fax: 980-533-7801
Mailing address:
  • Phone: 704-342-0252
  • Fax: 980-533-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number9300748
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: