Individual provider Active NPI

Peter Elliot Manley, MD

  • Pediatric Hematology & Oncology Physician
  • Boston, MA
National Provider Identifier
1477508372
Registry record updated Mar 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X
License
220520 Issued in MA
Practice address
44 Binney St
Boston, MA 02115-6013
Phone
(617) 632-4386
Fax
(617) 632-4897
NPI assigned
May 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Hematology & Oncology Physician 2080P0207X 11807 RI
Pediatric Hematology & Oncology Physician 2080P0207X 220520 MA Primary

Addresses

Primary practice location

44 Binney St
Boston, MA 02115-6013

Mailing address

450 Brookline Ave
Boston, MA 02215-5418
Phone (617) 632-4386

Other identifiers 1

IdentifierTypeStateIssuer
PM58407MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090421000522 MA Practitioner - Pediatric MedicinePractitioner - Hematology/Oncology 1557386653 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
11807RIMDPediatric Hematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dana-Farber Cancer Institute, Inc. CurrentSince Apr 20, 2009 Accepting new patients
Dana-Farber Cancer Institute, Inc. CurrentSince Apr 20, 2009 Accepting new patients
Dana-Farber Cancer Institute, Inc. Past Accepting new patients

Locations

300 Longwood Ave
Boston, MA 02115
Phone (617) 355-4956

44 Binney St
Boston, MA 02115
Phone (617) 632-3591

450 Brookline Ave
Boston, MA 02215
Phone (508) 478-2061

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331683200000",
    "number": "1477508372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 BROOKLINE AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022155418",
            "telephone_number": "617-632-4386",
            "fax_number": "617-632-4897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 BINNEY ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156013",
            "telephone_number": "617-632-4386",
            "fax_number": "617-632-4897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANLEY",
        "first_name": "PETER",
        "middle_name": "ELLIOT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2012-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "RI",
            "license": "11807",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "MA",
            "license": "220520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PM58407",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.