Provider Demographics
NPI:1407855810
Name:MANTHEY, BRETT ALLEN (DO)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:ALLEN
Last Name:MANTHEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2196
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-2196
Mailing Address - Country:US
Mailing Address - Phone:276-628-4232
Mailing Address - Fax:276-676-4552
Practice Address - Street 1:407 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-3407
Practice Address - Country:US
Practice Address - Phone:276-628-4232
Practice Address - Fax:276-676-4552
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201460207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00052646OtherRAILROAD MEDICARE
VA010391873Medicaid
MI013330A49Medicare PIN
VAP00052646OtherRAILROAD MEDICARE