Provider Demographics
NPI:1457519357
Name:MANUKYAN, MARIUXI CHERRIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIUXI
Middle Name:CHERRIE
Last Name:MANUKYAN
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 1:1800 ORLEANS ST
Mailing Address - Street 2:DEPT OF SURGERY, SHEIKH ZAYED TOWER, SUITE 6107-D
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0010
Mailing Address - Country:US
Mailing Address - Phone:410-955-2244
Mailing Address - Fax:410-955-1884
Practice Address - Street 1:1800 ORLEANS ST
Practice Address - Street 2:DEPT OF SURGERY, SHEIKH ZAYED TOWER, SUITE 6107-D
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0010
Practice Address - Country:US
Practice Address - Phone:410-955-2244
Practice Address - Fax:410-955-1884
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0115208600000X, 208600000X
MDD0081979208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340348705Medicaid
TX374770YKQHMedicare PIN