Provider Demographics
NPI:1275584880
Name:MANATIS, ANNA A (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:A
Last Name:MANATIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:A
Other - Last Name:MANATIS-LORNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:433 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3644
Mailing Address - Country:US
Mailing Address - Phone:508-778-4777
Mailing Address - Fax:508-771-9555
Practice Address - Street 1:795 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NORTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02191-2139
Practice Address - Country:US
Practice Address - Phone:781-337-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3048161Medicaid
MAJ08115Medicare PIN
MA3048161Medicaid