Provider Demographics
NPI:1124378971
Name:KVEZERELI, MANANA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MANANA
Middle Name:
Last Name:KVEZERELI
Suffix:
Gender:F
Credentials:MD, PHD
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
Mailing Address - Street 2:BOX 802
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1533
Mailing Address - Country:US
Mailing Address - Phone:617-636-5829
Mailing Address - Fax:617-636-8302
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:BOX 802
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-5829
Practice Address - Fax:617-636-8302
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA252734207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology