Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 216504 | MA |
N | 207QS0010X | Family Doctor - Sports Medicine | 216504 | MA |
NPI | 1033165949 |
---|---|
Provider Name | Dr. Lee A Mancini |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01605-2138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2075393 | (05) | MA |
I10550 | (02) | MA |