Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN1856921 | MA |
Y | 213EG0000X | General Practice | DN1856921 | MA |
NPI | 1003298472 |
---|---|
Provider Name | Dr. Andrew Henry Mancini |
First Address | Jamaica Plain, MA 02130-2552 |
Second Address | Jamaica Plain, MA 02130-2552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2015 |
Last Update Date | 16/11/2016 |