Provider Demographics
NPI:1154346336
Name:MANNING, CAROL (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 PITTSFORD VICTOR RD
Mailing Address - Street 2:D-2
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3825
Mailing Address - Country:US
Mailing Address - Phone:585-218-8007
Mailing Address - Fax:585-218-8099
Practice Address - Street 1:3320 N LOS COYOTES DIAGONAL
Practice Address - Street 2:SUITE 120, 112 & 260
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-3918
Practice Address - Country:US
Practice Address - Phone:562-627-0903
Practice Address - Fax:562-627-0923
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG403062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G403060Medicaid
CA00G403060OtherBLUE SHIELD
CAWG40306IMedicare PIN
CAWG40306OMedicare PIN
TG256AMedicare PIN
CAEG40306PMedicare PIN
CAWG40306NMedicare PIN
CAWG40306MMedicare PIN
CA00G403060Medicaid
CAWG40306KMedicare PIN
CATP051Medicare PIN
CATG256BMedicare PIN
CAWG40306LMedicare PIN
CATP009Medicare PIN
CA00G403060OtherBLUE SHIELD
CAE97880Medicare UPIN
CAWG40306RMedicare PIN
CAEG40306GMedicare PIN