Basic Information
| Provider Information | |||||||||
| NPI: | 1598729519 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANNING | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCULLY | ||||||||
| OtherFirstName: | CHRISTINA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | P.O. BOX 626 | ||||||||
| Address2: | SMMC PRIMECARE PHYSICIANS | ||||||||
| City: | BIDDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072829080 | ||||||||
| FaxNumber: | 2072863787 | ||||||||
| Practice Location | |||||||||
| Address1: | 9 HEALTHCARE DRIVE, SUITE 208 | ||||||||
| Address2: | SMMC PRIMECARE PEDIATRICS | ||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072827531 | ||||||||
| FaxNumber: | 2072863787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 11/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD16505 | ME | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1598729519 | 05 | ME | MEDICAID | 5680015 | 01 | ME | CIGNA | OTHER | 3538761 | 01 | ME | AETNA | OTHER | 1598729519 | 01 | ME | ANTHEM | OTHER | AA16518 | 01 | ME | HARVARD PILGRIM | OTHER |