Individual
DR. LARRY DOUGLAS MANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2406 BLUE RIDGE RD, SUITE 100, RALEIGH, NC 27607-6678
(919) 786-5001
(919) 786-5051
Mailing address
2406 BLUE RIDGE RD, SUITE 100, RALEIGH, NC 27607-6678
(919) 786-5001
(919) 786-5051
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
31574
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45876
BLUECROSSBLUESHIELD INS #
NC
05
—
8953871
—
NC
Enumeration date
02/01/2006
Last updated
07/08/2007
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