Provider Demographics
NPI:1275576670
Name:MANLEY, GENA T (MD)
Entity Type:Individual
Prefix:DR
First Name:GENA
Middle Name:T
Last Name:MANLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GENA
Other - Middle Name:E
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9707 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-279-6060
Mailing Address - Fax:301-279-6345
Practice Address - Street 1:6535 N CHARLES ST STE 406
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5826
Practice Address - Country:US
Practice Address - Phone:443-849-2568
Practice Address - Fax:443-849-2939
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046308207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD596091601Medicaid
MDS581M963Medicare PIN
S581M963Medicare PIN
MDF43154Medicare UPIN