Provider Demographics
NPI:1043590417
Name:MANHAN INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:MANHAN INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:DUGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:413-529-9282
Mailing Address - Street 1:2 MECHANIC ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1562
Mailing Address - Country:US
Mailing Address - Phone:413-529-9282
Mailing Address - Fax:413-527-7526
Practice Address - Street 1:2 MECHANIC ST
Practice Address - Street 2:SUITE A
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1562
Practice Address - Country:US
Practice Address - Phone:413-529-9282
Practice Address - Fax:413-527-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3058581Medicaid
MA3058581Medicaid