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General NPI Number Information
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NPI Number | 1548374234
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Entity Type | Individual
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Provider Name | JOHN HENRY MANI MD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 4610 KANAWHA AVE SW STE 401
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25309-1367
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Country | US
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Telephone | 304-768-7368
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Fax | 304-768-1829
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Provider Business Mailing Address
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Address Line | 4605 MACCORKLE AVE SW
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25309-1311
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Country | US
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Telephone | 304-414-4800
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Fax | 304-414-4801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 14168
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License Number State | WV
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