Individual
DIMITRA A MANESIS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2 ESSEX CENTER DR, INTERNAL MEDICINE, PEABODY, MA 01960-2902
(978) 977-4000
Mailing address
147 MILK ST, PROVIDER ENROLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8374
(617) 421-3487
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
52313
MA
207QA0505X
Adult Medicine Physician
Primary
52313
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0120871
—
MA
Enumeration date
04/20/2006
Last updated
09/11/2025
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