Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 34077714M | OH |
Y | 207P00000X | Emergency Physician | 35.077714 | OH |
N | 208200000X | Surgeon | 35.077714 | OH |
N | 208600000X | Surgeon | 35.077714 | OH |
NPI | 1013973395 |
---|---|
Provider Name | Dr. Maura Marie Manning |
First Address | Kettering, OH 45429-5164 |
Second Address | Bucyrus, OH 44820-1821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 09/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000244441 | BCBS MARION (01) | OH |
000000316695 | BCBS FOR BUCYRUS (01) | OH |
2178656 | (05) | OH |
F86594 | (02) |