Provider Demographics
NPI:1669492849
Name:MANN, DOUGLAS G (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:G
Last Name:MANN
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 1:200 A JONES RD.
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540
Mailing Address - Country:US
Mailing Address - Phone:508-540-0900
Mailing Address - Fax:508-548-6358
Practice Address - Street 1:200 JONES RD # A
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-4900
Practice Address - Country:US
Practice Address - Phone:508-540-0900
Practice Address - Fax:508-548-6358
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219845207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA468745OtherTUFTS
MAJ27152OtherBCBS PROVIDER #
MAAA9901OtherHARVRD PILGRIM HEALTH CAR
MA2034140Medicaid
MA3485221OtherAETNA
MAJ27152OtherBCBS PROVIDER #
MAM18425Medicare ID - Type Unspecified