Provider Demographics
NPI:1588892616
Name:MANN, ALAN THOMAS (DO)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:THOMAS
Last Name:MANN
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 1:167 ASHLEY AVE
Mailing Address - Street 2:SUITE 301, MSC 912
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-9120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:167 ASHLEY AVE
Practice Address - Street 2:SUITE 301, MSC 912
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-9120
Practice Address - Country:US
Practice Address - Phone:843-792-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL1275207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology