Provider Demographics
NPI:1659480283
Name:MANIAN, FARRIN ALAN (MD,PHD)
Entity type:Individual
Prefix:
First Name:FARRIN
Middle Name:ALAN
Last Name:MANIAN
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STANIFORD STREET
Mailing Address - Street 2:S50-503B
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-643-0604
Mailing Address - Fax:617-724-9428
Practice Address - Street 1:50 STANIFORD STREET
Practice Address - Street 2:S50-503B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-643-0604
Practice Address - Fax:617-724-9428
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4F74174400000X, 207R00000X
MA254493207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO001012024Medicare PIN
MOA1046Medicare UPIN