Provider Demographics
NPI:1902072382
Name:MANNING, CLYDE VERNON (MD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:VERNON
Last Name:MANNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43025 BROOKTON WAY
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-7414
Mailing Address - Country:US
Mailing Address - Phone:703-577-9017
Mailing Address - Fax:
Practice Address - Street 1:43025 BROOKTON WAY
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7414
Practice Address - Country:US
Practice Address - Phone:703-577-9017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine