Healthcare Provider Details

I. General information

NPI: 1508063371
Provider Name (Legal Business Name): MANTE PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 W MEETING ST SUITE C
LANCASTER SC
29720-6220
US

IV. Provider business mailing address

834 W MEETING ST SUITE C
LANCASTER SC
29720-6220
US

V. Phone/Fax

Practice location:
  • Phone: 803-313-3846
  • Fax: 803-313-3847
Mailing address:
  • Phone: 803-313-3846
  • Fax: 803-313-3847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: EBENEZER MANTE
Title or Position: OWNER
Credential: M.D.
Phone: 803-313-3846