Provider Demographics
NPI:1023252251
Name:MCMANUS, JULIA TAKAHASHI (MD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:TAKAHASHI
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 1:1135 MORTON STREET
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126
Mailing Address - Country:US
Mailing Address - Phone:617-533-2300
Mailing Address - Fax:617-533-2341
Practice Address - Street 1:398 NEPONSET AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122
Practice Address - Country:US
Practice Address - Phone:617-282-3200
Practice Address - Fax:617-825-8577
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251836174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty