Provider Demographics
NPI:1457548000
Name:GEORGE B MCMANAMA JR MD PC
Entity Type:Organization
Organization Name:GEORGE B MCMANAMA JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCMANAMA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD PC
Authorized Official - Phone:617-698-5198
Mailing Address - Street 1:PO BOX 52378
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02205-2378
Mailing Address - Country:US
Mailing Address - Phone:617-698-5198
Mailing Address - Fax:617-698-7542
Practice Address - Street 1:100 HIGHLAND ST
Practice Address - Street 2:STE G1
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3881
Practice Address - Country:US
Practice Address - Phone:617-698-5198
Practice Address - Fax:617-698-7542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB76027Medicare UPIN
MA2089319Medicaid