MEDICARE: MRS. ESTHER OLAJIDE MANNER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	C0004756	MD

General Provider Information

NPI Number	:	1154681914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ESTHER OLAJIDE MANNER PA

Provider Business Mailing Address
First Line	:	11510 OLD GEORGETOWN RD
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-2736
Country	:	US
Telephone Number	:	301-881-4124
Fax Number	:

Provider Business Practice Location Address
First Line	:	2906 KINGSWELL DR
Second Line	:
City	:	WHEATON
State	:	MD
Zip	:	20902-2127
Country	:	US
Telephone Number	:	301-646-4001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2012
Last Update Date	:	01/07/2022

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