Individual
MANUEL ANTONIA DE PINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1025 VERDAE BLVD, SUITE B, GREENVILLE, SC 29607-4032
(864) 286-7550
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6307
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
20807
SC
207Q00000X
Family Medicine Physician
Primary
20807
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208073
—
SC
01
—
P00095900
MEDICARE RAILROAD
SC
Enumeration date
07/09/2006
Last updated
10/31/2016
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