1598729519 NPI number — CHRISTINA S MANNING M.D.

Table of content: CHRISTINA S MANNING M.D. (NPI 1598729519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598729519 NPI number — CHRISTINA S MANNING M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANNING
Provider First Name:
CHRISTINA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCULLY
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598729519
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 626
Provider Second Line Business Mailing Address:
SMMC PRIMECARE PHYSICIANS
Provider Business Mailing Address City Name:
BIDDDEFORD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-282-9080
Provider Business Mailing Address Fax Number:
207-286-3787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 HEALTHCARE DRIVE, SUITE 208
Provider Second Line Business Practice Location Address:
SMMC PRIMECARE PEDIATRICS
Provider Business Practice Location Address City Name:
BIDDEFORD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-282-7531
Provider Business Practice Location Address Fax Number:
207-286-3787
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD16505 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1598729519 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5680015 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 3538761 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1598729519 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: AA16518 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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