Provider Demographics
NPI:1699776955
Name:MANSUETI, JOHN ROMEO (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROMEO
Last Name:MANSUETI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 418837
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8837
Mailing Address - Country:US
Mailing Address - Phone:607-324-2340
Mailing Address - Fax:607-324-7615
Practice Address - Street 1:11105 CATHAGE RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-2131
Practice Address - Country:US
Practice Address - Phone:410-912-4966
Practice Address - Fax:410-912-5967
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012284332085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology