Provider Demographics
NPI:1124145784
Name:MCMANUS, GEORGE L (PA)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:L
Last Name:MCMANUS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:L
Other - Last Name:SOUTHWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 PARKER HILL AVE
Mailing Address - Street 2:OCCUPATIONAL MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2847
Mailing Address - Country:US
Mailing Address - Phone:617-784-7164
Mailing Address - Fax:617-754-6453
Practice Address - Street 1:125 PARKER HILL AVE
Practice Address - Street 2:OCCUPATIONAL MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-2847
Practice Address - Country:US
Practice Address - Phone:617-784-7164
Practice Address - Fax:617-754-6453
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0533363A00000X
MAPA2512363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant