Provider Demographics
NPI:1104897537
Name:MANNING, STEWART CLEAVES (MD)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:CLEAVES
Last Name:MANNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 N ROAD ST
Mailing Address - Street 2:STE A
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3353
Mailing Address - Country:US
Mailing Address - Phone:252-338-2144
Mailing Address - Fax:252-338-2145
Practice Address - Street 1:1121 N ROAD ST STE A
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3470
Practice Address - Country:US
Practice Address - Phone:252-338-2144
Practice Address - Fax:252-338-2145
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38380174400000X, 207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1891908422OtherMEDICARE NPI GROUP
NC6953907Medicaid
NC6953907Medicaid