Provider Demographics
NPI:1427891274
Name:MANN, WILLIAM (PR)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MANN
Suffix:
Gender:M
Credentials:PR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 8TH AVE W
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2510
Mailing Address - Country:US
Mailing Address - Phone:304-408-3256
Mailing Address - Fax:304-756-8230
Practice Address - Street 1:137 8TH AVE W
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2510
Practice Address - Country:US
Practice Address - Phone:304-408-3256
Practice Address - Fax:304-756-8230
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24-969175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty