1306971486 NPI number — DR. TERI MANOLIO M.D., PH.D.

Table of content: DR. TERI MANOLIO M.D., PH.D. (NPI 1306971486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306971486 NPI number — DR. TERI MANOLIO M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANOLIO
Provider First Name:
TERI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D.
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1306971486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6700B ROCKLEDGE DR
Provider Second Line Business Mailing Address:
RM 3118, MSC 6908
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20892-6908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-274-1256
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WALTER REED NATIONAL MILITARY MEDICAL CENTER
Provider Second Line Business Practice Location Address:
8901 ROCKVILLE PIKE
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20889-5600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-295-4611
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2007

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: 207R00000X , with the licence number:  D0036136 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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