Healthcare Provider Details

I. General information

NPI: 1245236959
Provider Name (Legal Business Name): STEVEN P MANULI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date: 03/17/2006
Reactivation Date: 03/24/2006

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:
Title or Position:
Credential:
Phone: