Manny, Theodore Bergen

Manny, Theodore Bergen is an individual health care provider with primary practice located at 509 N Elam Ave Fl 2 , Greensboro NC 27403-1157. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Manny, Theodore Bergen can be contacted via phone (336) 274-1114.

Contact Information

Primary practice address
509 N Elam Ave Fl 2 Greensboro NC 27403-1157
Phone: (336) 274-1114
Fax: (336) 274-9638
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X 2012-00902 North Carolina

Profile Details

NPI number 1871773143
LBN Legal business name Manny, Theodore Bergen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 5th, 2007
Last updated Jun 25th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871773143 NPPES
North Carolina MEDICAID 5921067

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