Individual
DR. JONATHAN M MANSBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-7181
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-7181
Taxonomy
Speciality
Code
Description
License number
State
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
160172
MA
208000000X
Pediatrics Physician
160172
MA
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
160172
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0116777
—
MA
Enumeration date
11/01/2006
Last updated
09/03/2015
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