Provider Demographics
NPI:1164436812
Name:MANESIS-GILBERT, MARY CATHERINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CATHERINE
Last Name:MANESIS-GILBERT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:888 WORCESTER ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-3744
Mailing Address - Country:US
Mailing Address - Phone:617-964-6681
Mailing Address - Fax:339-686-2561
Practice Address - Street 1:888 WORCESTER ST
Practice Address - Street 2:SUITE 130
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-3744
Practice Address - Country:US
Practice Address - Phone:617-964-6681
Practice Address - Fax:339-686-2561
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1956213E00000X
NH0240213E00000X
TX1713213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171675501Medicaid
NH30009080Medicaid
MA0357804Medicaid
TXP00259202OtherMEDICARE RAILROAD
480013145OtherMEDICARE RAILROAD
MAY70952OtherBLUE CROSS BLUE SHIELD
480013145OtherMEDICARE RAILROAD
MA0357804Medicaid
TX171675501Medicaid
TX8D2879Medicare PIN