Provider Demographics
NPI:1225067838
Name:MANNING, MARY E (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:MANNING
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2410
Mailing Address - Country:US
Mailing Address - Phone:781-455-6200
Mailing Address - Fax:781-449-1096
Practice Address - Street 1:272 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2410
Practice Address - Country:US
Practice Address - Phone:781-455-6200
Practice Address - Fax:781-449-1096
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3124061Medicaid
MAJ30530Medicare ID - Type Unspecified
MAB99060Medicare UPIN