Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 52313 | MA |
N | 207QA0505X | Family Doctor - Adult Medicine | 52313 | MA |
NPI | 1023074952 |
---|---|
Provider Name | Dimitra A Manesis |
First Address | Boston, MA 02109-4806 |
Second Address | Peabody, MA 01960-2902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0120871 | (05) | MA |
F40459 | (02) | MA |