MEDICARE: JULIANA ATEI OFORI-MANTE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	2011-00655	NC

General Provider Information

NPI Number	:	1396858619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANA ATEI OFORI-MANTE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-384-7840
Fax Number	:	704-384-7830

Provider Business Practice Location Address
First Line	:	13557 STEELECROFT PKWY
Second Line	:	SUITE 2200
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-7550
Country	:	US
Telephone Number	:	704-316-1080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	06/12/2023

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