Individual
MANOUCHER LANCE TAVANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
TRN7995
FL
2086S0105X
Surgery of the Hand (Surgery) Physician
Primary
35075
SC
2086S0122X
Plastic and Reconstructive Surgery Physician
35075
SC
2086S0122X
Plastic and Reconstructive Surgery Physician
ME101855
FL
Other
Enumeration date
07/20/2007
Last updated
04/21/2023
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