Individual
DR. MICHAEL MANNSTADT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, WANG ACC 730A ENDOCRINE ASSOCIATES, BOSTON, MA 02114-2621
(617) 726-8720
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 726-8720
(617) 724-2718
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
217401
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2100240
—
MA
01
—
468146
TUFTS HEALTH PLAN
MA
01
—
J28524
BCBS MA
MA
Enumeration date
11/08/2005
Last updated
08/01/2012
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