Provider Demographics
NPI:1023217908
Name:MANOS, GINGER LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:GINGER
Middle Name:LYNNE
Last Name:MANOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:600 CANALSIDE ST UNIT 4024
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-6050
Mailing Address - Country:US
Mailing Address - Phone:850-398-2548
Mailing Address - Fax:
Practice Address - Street 1:3 RICHLAND MEDICAL PARK DR STE 330
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6862
Practice Address - Country:US
Practice Address - Phone:803-434-7100
Practice Address - Fax:803-434-6889
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1121232086S0129X
SC324872086S0129X
ALMD321272086S0129X
SCMD324872086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012102000Medicaid
AL161998Medicaid
FLHV310AMedicare PIN
AL161998Medicaid