MEDICARE: DR. ANJU A. MANI MD

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	207ZC0500X	Cytopathology Physician	L4555	TX
2	207ZP0101X	Anatomic Pathology Physician	L4555	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588652937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANJU A. MANI MD

Provider Business Mailing Address
First Line	:	PO BOX 30309
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29417-0309
Country	:	US
Telephone Number	:	843-554-9300
Fax Number	:	843-566-8780

Provider Business Practice Location Address
First Line	:	1625 MEDICAL CENTER DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-5005
Country	:	US
Telephone Number	:	915-747-4038
Fax Number	:	915-747-2678

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	01/30/2008

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