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General NPI Number Information
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NPI Number | 1497801260
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Entity Type | Individual
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Provider Name | MARY ELIZABETH MANISCALCO-THEBERGE M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 8901 ROCKVILLE PIKE DEPARTMENT OF SURGERY, NATIONAL NAVAL MEDICAL CENTER
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City | BETHESDA
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State | MD
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Zip | 20889-0001
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Country | US
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Telephone | 301-295-0290
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Fax |
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Provider Business Mailing Address
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Address Line | 11408 TOWERING OAK WAY
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City | RESTON
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State | VA
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Zip | 20194-1000
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Country | US
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Telephone | 202-461-4089
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Fax | 202-501-2196
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 28689
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License Number State | GA
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