Provider Demographics
NPI:1578552022
Name:FARDI, MANUCHER (MD)
Entity Type:Individual
Prefix:
First Name:MANUCHER
Middle Name:
Last Name:FARDI
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 1:58 EDGELAWN AVE
Mailing Address - Street 2:UNIT #12
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-4479
Mailing Address - Country:US
Mailing Address - Phone:978-944-0981
Mailing Address - Fax:978-466-9333
Practice Address - Street 1:105 ERDMAN WAY
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1805
Practice Address - Country:US
Practice Address - Phone:978-466-7800
Practice Address - Fax:978-466-9333
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78320207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA078320OtherTUFTS
MAAA8479OtherHPHC
MAJ17221OtherBCBS
MA3159531Medicaid
MAAA8479OtherHPHC
MA078320OtherTUFTS