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General NPI Number Information
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NPI Number | 1952595373
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Entity Type | Individual
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Provider Name | BENJAMIN LOWELL MANN PA
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Gender | Male
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 312 FAIRY STREET EXT STE 201
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City | MARTINSVILLE
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State | VA
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Zip | 24112-1912
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Country | US
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Telephone | 276-632-6496
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Fax | 276-632-6701
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-01004
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License Number State | NC
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