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General NPI Number Information
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NPI Number | 1508063371
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Entity Type | Organization
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Legal Business Name | MANTE PEDIATRICS LLC
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 834 W MEETING ST SUITE C
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City | LANCASTER
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State | SC
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Zip | 29720-6220
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Country | US
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Telephone | 803-313-3846
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Fax | 803-313-3847
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Provider Business Mailing Address
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Address Line | 834 W MEETING ST SUITE C
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City | LANCASTER
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State | SC
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Zip | 29720-6220
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Country | US
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Telephone | 803-313-3846
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Fax | 803-313-3847
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Authorized Official
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Title or Position | OWNER
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Name | EBENEZER MANTE
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Credential | M.D.
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Telephone | 803-313-3846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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