Provider Demographics
NPI:1952364184
Name:MCMANAMA, GEORGE BENSON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BENSON
Last Name:MCMANAMA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 HIGHLAND ST
Mailing Address - Street 2:SUITE G1
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3881
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:SUITE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2014-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA38991207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2089319Medicaid
MAB76027Medicare UPIN
MAM09267Medicare ID - Type Unspecified