Provider Demographics
NPI:1225010820
Name:MANICA, VIRGIL SERBAN (MD)
Entity Type:Individual
Prefix:
First Name:VIRGIL
Middle Name:SERBAN
Last Name:MANICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WASHINGTON ST
Mailing Address - Street 2:DEPT. OF ANESTHESIA - TUFTS NEMC
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1526
Mailing Address - Country:US
Mailing Address - Phone:617-636-9310
Mailing Address - Fax:617-636-8384
Practice Address - Street 1:750 WASHINGTON ST
Practice Address - Street 2:DEPT. OF ANESTHESIA - TUFTS NEMC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-9310
Practice Address - Fax:617-636-8384
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71484207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3076741Medicaid
MAE83409Medicare UPIN
MA3076741Medicaid