MEDICARE: DR. MARC MANIGAT M.D.

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	42027	MA

General Provider Information

NPI Number	:	1629028659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC MANIGAT M.D.

Provider Business Mailing Address
First Line	:	131 EMERALD ST
Second Line	:	WRENTHAM DEVELOPMENTAL CENTER
City	:	WRENTHAM
State	:	MA
Zip	:	02093-1902
Country	:	US
Telephone Number	:	508-384-1687
Fax Number	:	508-384-8938

Provider Business Practice Location Address
First Line	:	131 EMERALD ST
Second Line	:	WRENTHAM DEVELOPMENTAL CENTER
City	:	WRENTHAM
State	:	MA
Zip	:	02093-1902
Country	:	US
Telephone Number	:	508-384-5567
Fax Number	:	508-384-8938

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	10/06/2015

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