Individual
DR. THEODORE BERGEN MANNY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
509 N ELAM AVE FL 2, GREENSBORO, NC 27403-1157
(336) 274-1114
(336) 274-9638
Mailing address
509 N ELAM AVE FL 2, GREENSBORO, NC 27403-1157
(336) 274-1114
(336) 232-5325
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
2012-00902
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5921067
—
NC
Enumeration date
11/05/2007
Last updated
06/25/2013
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