Provider Demographics
NPI:1154681914
Name:MANNER, ESTHER OLAJIDE (PA)
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:OLAJIDE
Last Name:MANNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11510 OLD GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2736
Mailing Address - Country:US
Mailing Address - Phone:301-881-4124
Mailing Address - Fax:
Practice Address - Street 1:2906 KINGSWELL DR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-2127
Practice Address - Country:US
Practice Address - Phone:301-646-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004756363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical