Individual
DR. MANUEL ANTONIO FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1925 HOFFMEYER RD, FLORENCE, SC 29501-4011
(843) 679-4214
(843) 674-5146
Mailing address
PO BOX 23321, NEW YORK, NY 10087-3321
(843) 679-4214
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0419
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004195
—
SC
Enumeration date
12/06/2005
Last updated
01/28/2025
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