Healthcare Provider Details

I. General information

NPI: 1720096217
Provider Name (Legal Business Name): MARIA MANION M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 JOLIET ST
DYER IN
46311-1705
US

IV. Provider business mailing address

1040 SIERRA DR SUITE 400
GREENWOOD IN
46143-7240
US

V. Phone/Fax

Practice location:
  • Phone: 219-322-5747
  • Fax: 219-864-2282
Mailing address:
  • Phone: 317-865-8988
  • Fax: 317-859-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01064356A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01064356A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: