Provider Demographics
NPI:1881670396
Name:MANNING, MARY BETH (MD)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:MANNING
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 1:5700 DARROW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5021
Mailing Address - Country:US
Mailing Address - Phone:330-656-9304
Mailing Address - Fax:330-656-5901
Practice Address - Street 1:44 BLAINE AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2709
Practice Address - Country:US
Practice Address - Phone:440-735-3900
Practice Address - Fax:330-656-5901
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058161M207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000381220OtherANTHEM
OH0807550Medicaid
OH000000162489OtherANTHEM
OH000000381220OtherANTHEM
OH0807550Medicaid
E69089Medicare UPIN
OHP00120453Medicare PIN