Healthcare Provider Details

I. General information

NPI: 1235333584
Provider Name (Legal Business Name): MANULI INTERNAL MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MILL END CT
ELIZABETH CITY NC
27909-8986
US

IV. Provider business mailing address

104 MILL END CT
ELIZABETH CITY NC
27909-8986
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-5183
  • Fax: 252-338-5669
Mailing address:
  • Phone: 252-338-5183
  • Fax: 252-338-5669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9601393
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number182382
License Number StateNC

VIII. Authorized Official

Name: STEVEN P MANULI
Title or Position: CEO
Credential: MD
Phone: 252-338-5183