Provider Demographics
NPI:1114984820
Name:LOCONTE, MANLIO AUGUSTUS (MD, MPH, FCAP)
Entity Type:Individual
Prefix:
First Name:MANLIO
Middle Name:AUGUSTUS
Last Name:LOCONTE
Suffix:
Gender:M
Credentials:MD, MPH, FCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WASHINGTON STREET BOX 1013
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:781-861-9649
Mailing Address - Fax:781-863-8031
Practice Address - Street 1:800 WASHINGTON STREET BOX 1013
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36288207ZP0101X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB23086OtherBLUE CROSS
220019990OtherRAILROAD MEDICARE
MA036288OtherTUFTS
MA6188206Medicaid
MA33089OtherFALLON
MA34747OtherHARVARD PILGRIM
MAB2308603Medicare PIN
MA036288OtherTUFTS
B23086Medicare ID - Type Unspecified