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Individual

NATHANIEL MANNING

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
320 POMFRET ST, PUTNAM, CT 06260-1836
(860) 928-6541
(860) 963-6368
Mailing address
PO BOX 409010, ATLANTA, GA 30384-9010
(800) 377-8721
(304) 523-2241

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
040347
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
500HBE168CT01
BLUECROSS BLUESHIELD
CT
Enumeration date
02/15/2006
Last updated
07/08/2007
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