Provider Demographics
NPI:1962840678
Name:MANNING, MADELINE (DO)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 HARRIS PKWY STE 235
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4126
Mailing Address - Country:US
Mailing Address - Phone:817-776-4722
Mailing Address - Fax:
Practice Address - Street 1:6100 HARRIS PKWY STE 235
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4126
Practice Address - Country:US
Practice Address - Phone:817-776-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4272207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology