Individual
DR. TARA BETH MANCL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
109 BRIDGE ST STE 202, DANVILLE, VA 24541-1222
(434) 792-5964
Mailing address
1000 OAKLAND DR, KALAMAZOO, MI 49008-1282
(269) 337-4400
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101263573
VA
208600000X
Surgery Physician
4301085737
MI
390200000X
Student in an Organized Health Care Education/Training Program
4301085737
MI
Other
Enumeration date
06/06/2007
Last updated
03/17/2018
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