Healthcare Provider Details

I. General information

NPI: 1013973395
Provider Name (Legal Business Name): MAURA MARIE MANNING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 S 3RD ST
COLUMBUS OH
43215-5702
US

IV. Provider business mailing address

480 S 3RD ST
COLUMBUS OH
43215-5702
US

V. Phone/Fax

Practice location:
  • Phone: 614-512-9665
  • Fax:
Mailing address:
  • Phone: 614-512-9665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34077714M
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number35.077714
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.077714
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: