Individual
MARK MANZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
210 PARK AVE STE 163, WORCESTER, MA 01609-2246
(508) 752-0843
Mailing address
210 PARK AVE STE 163, WORCESTER, MA 01609-2246
(508) 752-0843
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA3715
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9773312
—
MA
Enumeration date
05/29/2009
Last updated
11/20/2015
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