Individual
JOHN T H MANDEVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PHD
Contact information
Practice address
97 LIBBEY INDUSTRIAL PKWY STE 100, EAST WEYMOUTH, MA 02189-3110
(781) 331-3300
(781) 337-8356
Mailing address
97 LIBBEY INDUSTRIAL PKWY STE 100, EAST WEYMOUTH, MA 02189-3110
(781) 331-3300
(781) 337-8356
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
209475
MA
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
209475
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0174629
—
MA
Enumeration date
10/20/2005
Last updated
12/23/2021
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