Provider Demographics
NPI:1114970233
Name:MANNON, STUART B (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:B
Last Name:MANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 E US HIGHWAY 36 STE 100
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6646
Mailing Address - Country:US
Mailing Address - Phone:888-714-1927
Mailing Address - Fax:317-272-0807
Practice Address - Street 1:6655 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8923
Practice Address - Country:US
Practice Address - Phone:888-714-1927
Practice Address - Fax:317-272-0807
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010327482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000083191OtherANTHEM BCBS PROVIDER PIN
IN200009770Medicaid
IN000000083191OtherANTHEM BCBS PROVIDER PIN
IN344840B3Medicare PIN