Individual
MARC ANGELO MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
700 E MOREHEAD ST STE 300, CHARLOTTE, NC 28202-2742
(704) 334-7800
(704) 414-7512
Mailing address
700 E MOREHEAD ST STE 300, CHARLOTTE, NC 28202-2742
(704) 334-7800
(704) 414-7512
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
200700335
NC
2085R0202X
Diagnostic Radiology Physician
12626
NH
2085R0202X
Diagnostic Radiology Physician
Primary
200700335
NC
2085R0202X
Diagnostic Radiology Physician
227556
MA
2085R0202X
Diagnostic Radiology Physician
29892
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5906571
—
NC
05
—
N00337
—
SC
01
—
P00410888
RR MEDICAIRE
NC
Enumeration date
12/19/2005
Last updated
12/20/2017
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