Individual
MANUEL A DORNA-PESQUERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
135 COMMONWEALTH DR. STE. 100, GREENVILLE, SC 29615-6940
(864) 263-4444
(864) 263-4445
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19414
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
194140
—
SC
01
—
P01195502
RAILROAD MEDICARE
SC
Enumeration date
12/15/2005
Last updated
12/23/2020
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