Provider Demographics
NPI:1124033907
Name:MANZANO, RAMIRO J (MD)
Entity Type:Individual
Prefix:
First Name:RAMIRO
Middle Name:J
Last Name:MANZANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:94 OLD RIGHT RD
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-1052
Mailing Address - Country:US
Mailing Address - Phone:617-983-1900
Mailing Address - Fax:617-983-8122
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:SUITE 5980
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-983-1900
Practice Address - Fax:617-983-8122
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2029213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
27-40037OtherUNITED
762352OtherTUFTS
MA0307343Medicaid
Y70991Medicare PIN
MA0307343Medicaid