Provider Demographics
NPI:1285800680
Name:MANLEY, MOLLIE O (MD)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:O
Last Name:MANLEY
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 1:3925 EMBASSY PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-8400
Mailing Address - Country:US
Mailing Address - Phone:330-668-4040
Mailing Address - Fax:330-668-4077
Practice Address - Street 1:3925 EMBASSY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-8400
Practice Address - Country:US
Practice Address - Phone:330-668-4055
Practice Address - Fax:330-668-4077
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.126454207XS0106X
OH35126454207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0132246Medicaid
OH0132246Medicaid