Provider Demographics
NPI:1962588897
Name:MANN, BRIAN (PA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MANN
Suffix:
Gender:M
Credentials:PA
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 843298
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3298
Mailing Address - Country:US
Mailing Address - Phone:910-215-5100
Mailing Address - Fax:910-215-5114
Practice Address - Street 1:7473 C HWY 22
Practice Address - Street 2:
Practice Address - City:WHISPERING PINES
Practice Address - State:NC
Practice Address - Zip Code:28327-0000
Practice Address - Country:US
Practice Address - Phone:910-215-5100
Practice Address - Fax:910-215-5114
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001829363A00000X
NC11548363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant