Healthcare Provider Details

I. General information

NPI: 1659353076
Provider Name (Legal Business Name): MANORA SZETO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ALFRED ST
WOBURN MA
01801-1976
US

IV. Provider business mailing address

15 GAUCHER CIR
MARLBOROUGH MA
01752-5009
US

V. Phone/Fax

Practice location:
  • Phone: 781-933-6236
  • Fax:
Mailing address:
  • Phone: 774-249-8761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number153649
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3168972
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: