MEDICARE: MANI GEORGE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	48690	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497843650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANI GEORGE MD

Provider Business Mailing Address
First Line	:	725 NORTH ST
Second Line	:
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-4109
Country	:	US
Telephone Number	:	413-447-2752
Fax Number	:	413-496-6836

Provider Business Practice Location Address
First Line	:	27 LEWIS AVE
Second Line	:
City	:	GT BARRINGTON
State	:	MA
Zip	:	01230-1886
Country	:	US
Telephone Number	:	413-528-5006
Fax Number	:	413-528-6743

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	10/19/2011

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