Provider Demographics
NPI:1699848903
Name:MCMANUS, DIANA K (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:K
Last Name:MCMANUS
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 1:378 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2675
Mailing Address - Country:US
Mailing Address - Phone:508-852-8570
Mailing Address - Fax:508-852-1022
Practice Address - Street 1:630 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-852-8570
Practice Address - Fax:508-852-1022
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230479208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2128535Medicaid
MA2128535Medicaid