Provider Demographics
NPI:1013973395
Name:MANNING, MAURA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURA
Middle Name:MARIE
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 1:480 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5702
Mailing Address - Country:US
Mailing Address - Phone:614-512-9665
Mailing Address - Fax:
Practice Address - Street 1:480 S 3RD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5702
Practice Address - Country:US
Practice Address - Phone:614-512-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34077714M207P00000X
OH35.077714207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000316695OtherBCBS FOR BUCYRUS
OH2178656Medicaid
OH000000244441OtherBCBS MARION
OH000000244441OtherBCBS MARION
MA4045282Medicare PIN
MA4045284Medicare PIN
OH000000316695OtherBCBS FOR BUCYRUS
OHP00112953Medicare PIN