Provider Demographics
NPI:1497870281
Name:MANSON, JOANN E (MD)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:E
Last Name:MANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5820
Mailing Address - Country:US
Mailing Address - Phone:617-278-0871
Mailing Address - Fax:
Practice Address - Street 1:BRIGHAM & WOMEN'S HOSP
Practice Address - Street 2:900 COMMONWEALTH AVE E.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1204
Practice Address - Country:US
Practice Address - Phone:617-278-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47108207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine