Healthcare Provider Details

I. General information

NPI: 1417064825
Provider Name (Legal Business Name): MANHAL M TANNOUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL PARK STE 223
WHEELING WV
26003-6391
US

IV. Provider business mailing address

30 MEDICAL PARK STE 223
WHEELING WV
26003-6391
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-7928
  • Fax: 304-243-2928
Mailing address:
  • Phone: 304-243-7928
  • Fax: 304-243-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number29890
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD459392
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35547
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: