Healthcare Provider Details

I. General information

NPI: 1568565760
Provider Name (Legal Business Name): ALAN RICHARD MANIET DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALAN RICHARD MANIET DO

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 N ROAD ST SUITE 9
ELIZABETH CITY NC
27909-3365
US

IV. Provider business mailing address

1134 N ROAD ST STE 9
ELIZABETH CITY NC
27909-3365
US

V. Phone/Fax

Practice location:
  • Phone: 252-331-1100
  • Fax: 252-338-9170
Mailing address:
  • Phone: 252-331-1100
  • Fax: 252-338-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number200301381
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2000151772
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: