Healthcare Provider Details

I. General information

NPI: 1780731794
Provider Name (Legal Business Name): PATRICIA MARY MANNING-COURTNEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 BURNET AVE. MLC 4002
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3430 BURNET AVE. MLC 4002
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-363-4611
  • Fax: 513-636-3800
Mailing address:
  • Phone: 513-363-4611
  • Fax: 513-636-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number35067708
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: