Provider Demographics
NPI:1730859083
Name:MANSON, JOHN DOUGLAS
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DOUGLAS
Last Name:MANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4210
Mailing Address - Country:US
Mailing Address - Phone:857-408-3735
Mailing Address - Fax:
Practice Address - Street 1:240 ALBANY ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4210
Practice Address - Country:US
Practice Address - Phone:857-408-3735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator