Provider Demographics
NPI:1700859170
Name:MANNING, WILLIAM J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:MANNING
Suffix:JR
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 1:700 ATTUCKS LANE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-771-0169
Mailing Address - Fax:508-790-1522
Practice Address - Street 1:700 ATTUCKS LANE
Practice Address - Street 2:SUITE 1A
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-771-0169
Practice Address - Fax:508-790-1522
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48448207X00000X
CT020356207X00000X
MA49448207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000027573OtherBOSTON MEDICAL CENTER
MA200040407OtherRAILROAD MEDICARE
MA17063OtherHARVARD PILGRIM
MA6789580004OtherCIGNA
MA706697OtherTUFTS
MA2463146OtherAETNA
49448OtherMA LICENSE
MA0166537Medicaid
MAL15145OtherBCBS
MA2463146OtherAETNA
MAL15145OtherBCBS