Individual
ALEXA PHOTENE MANICKAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
75 FRANCIS ST, RADIOLOGY BRIGHAM & WOMANS HOSPITAL, BOSTON, MA 02115-6110
(617) 732-9801
Mailing address
75 FRANCIS ST, RADIOLOGY BRIGHAM & WOMANS HOSPITAL, BOSTON, MA 02115-6110
(617) 732-9801
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
79111
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3126463
—
MA
01
—
737692
TUFTS HEALTH PLAN
MA
01
—
J30631
BLUE CROSS BLUE SHIELD
MA
Enumeration date
12/19/2005
Last updated
04/13/2026
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