Provider Demographics
NPI:1306031570
Name:STEVEN A. MANALAN, MD PC
Entity Type:Organization
Organization Name:STEVEN A. MANALAN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:MANALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-345-0343
Mailing Address - Street 1:1480 JOHN FITCH HWY
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-2035
Mailing Address - Country:US
Mailing Address - Phone:978-345-0343
Mailing Address - Fax:
Practice Address - Street 1:1480 JOHN FITCH HWY
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-2035
Practice Address - Country:US
Practice Address - Phone:978-345-0343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37254174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9730168Medicaid