Healthcare Provider Details

I. General information

NPI: 1891908422
Provider Name (Legal Business Name): STEWART CLEAVES MANNING, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N ROAD ST STE A
ELIZABETH CITY NC
27909-3470
US

IV. Provider business mailing address

1121 N ROAD ST STE A
ELIZABETH CITY NC
27909-3470
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-2144
  • Fax: 252-338-2145
Mailing address:
  • Phone: 252-338-2144
  • Fax: 252-338-2145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number38380
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number38380
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEWART CLEAVES MANNING
Title or Position: DOCTOR
Credential: M.D.
Phone: 252-338-2144