MEDICARE: FAWN TIENNE MANNING D.O.

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	207V00000X	Obstetrics & Gynecology Physician	H0059003	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568457513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAWN TIENNE MANNING D.O.

Provider Business Mailing Address
First Line	:	2229 E BALTIMORE ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21231-2002
Country	:	US
Telephone Number	:	410-558-3951
Fax Number	:

Provider Business Practice Location Address
First Line	:	1838 GREENE TREE RD
Second Line	:	SUITE 380
City	:	PIKESVILLE
State	:	MD
Zip	:	21208-6391
Country	:	US
Telephone Number	:	410-415-5577
Fax Number	:	410-415-6682

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	06/05/2024

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