Healthcare Provider Details

I. General information

NPI: 1275576670
Provider Name (Legal Business Name): GENA T MANLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GENA E TAYLOR M.D.

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 N CHARLES ST STE 406
TOWSON MD
21204-5826
US

IV. Provider business mailing address

9707 MEDICAL CENTER DR SUITE 230
ROCKVILLE MD
20850
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-2568
  • Fax: 443-849-2939
Mailing address:
  • Phone: 301-279-6060
  • Fax: 301-279-6345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0046308
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number01094424A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberD0046308
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier596091601
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: