Provider Demographics
NPI:1740231729
Name:MANZO, GINA M (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:MANZO
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 1:97 LIBBEY PKWY
Mailing Address - Street 2:STE 204
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3110
Mailing Address - Country:US
Mailing Address - Phone:508-350-2350
Mailing Address - Fax:508-350-2318
Practice Address - Street 1:10 FORBES RD
Practice Address - Street 2:SUITE 190
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2605
Practice Address - Country:US
Practice Address - Phone:781-884-6300
Practice Address - Fax:781-884-6305
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine