Provider Demographics
NPI:1750428611
Name:MANAHAN, MICHELE ANN (MD)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ANN
Last Name:MANAHAN
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 1:601 NORTH CAROLINE ST.
Mailing Address - Street 2:JHOC 8TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287
Mailing Address - Country:US
Mailing Address - Phone:410-955-9472
Mailing Address - Fax:410-502-3092
Practice Address - Street 1:601 NORTH CAROLINE ST.
Practice Address - Street 2:JHOC 8TH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:410-955-9472
Practice Address - Fax:410-502-3092
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDQ8790208200000X
MDD0065913208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery