1295725836 NPI number — ASHAN MANOHAR M.D.

Table of content: ASHAN MANOHAR M.D. (NPI 1295725836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295725836 NPI number — ASHAN MANOHAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANOHAR
Provider First Name:
ASHAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295725836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
856 J CLYDE MORRIS BLVD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23601-1318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-316-5800
Provider Business Mailing Address Fax Number:
757-534-5190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20486 MARKET STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONANCOCK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-302-2700
Provider Business Practice Location Address Fax Number:
757-787-9262
Provider Enumeration Date:
10/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  037701 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 0101058609 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 037701 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0V6836 . This is a "HEALTHNET NE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010037701CT01 . This is a "ANTHEM BCBS CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2543604 . This is a "AETNA HMO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 7122039 . This is a "AETNA PPO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P1992625 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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