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Provider Information for 1780761312

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. JONATHAN M MANSBACH MD

Gender: MALE

Individual NPI: 1780761312

Calendar   Last Updated:  2015-09-03
  Certification Date: 

Details

Name Value
NPI 1780761312
Enumeration Date 2006-11-01
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: 617-355-7181 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: 617-355-7181 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID MA 0116777
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2080A0000X - Pediatrics Adolescent Medicine MA 160172
No 207RA0000X - Internal Medicine Adolescent Medicine MA 160172
No 208000000X - Pediatrics MA 160172