Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 29936 | SC |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 29936 | SC |
NPI | 1053362269 |
---|---|
Provider Name | Joseph Andrew Manfredi |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29605-4630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 14/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
29936 | (05) | SC |
299368 | (05) | SC |
AA49317951 | (02) | SC |
GP1453 | (05) | SC |
GP2312 | (05) | SC |
GP2315 | (05) | SC |
H66787 | (02) | SC |