Individual
KENNETH RUSSELL MANNING
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1638 OWEN DR, FAYETTEVILLE, NC 28304-3424
(910) 609-6910
(910) 609-5219
Mailing address
PO BOX 42935, FAYETTEVILLE, NC 28309-2935
(910) 609-6910
(910) 609-5219
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
32779
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1297E
BCBS
NC
05
—
891297E
—
NC
Enumeration date
04/14/2006
Last updated
07/08/2007
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