Provider Demographics
NPI:1174584908
Name:MANI, OBLI CHETTY MARAGATHA (MD)
Entity type:Individual
Prefix:
First Name:OBLI
Middle Name:CHETTY MARAGATHA
Last Name:MANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 HANCOCK ST
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4339
Mailing Address - Country:US
Mailing Address - Phone:617-774-0840
Mailing Address - Fax:617-774-0882
Practice Address - Street 1:1250 HANCOCK ST
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4339
Practice Address - Country:US
Practice Address - Phone:617-774-0840
Practice Address - Fax:617-774-0882
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA89147207Q00000X
MA234649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A891470Medicaid
MA2161117Medicaid
I26226Medicare UPIN
MA000791901Medicare PIN
CAWA89147AMedicare PIN