Provider Demographics
NPI:1538162821
Name:MANALAN, STEVEN A (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:MANALAN
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 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:100 HOSPITAL ROAD
Practice Address - Street 2:SUITE 3C
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-466-3960
Practice Address - Fax:978-840-4670
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-03-07
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
MA37254174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110037666AMedicaid
MAA66989Medicare UPIN
MAM0967601Medicare PIN