1992727200 NPI number — DR. VIVEKANAND MANOCHA M.D.

Table of content: DR. VIVEKANAND MANOCHA M.D. (NPI 1992727200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992727200 NPI number — DR. VIVEKANAND MANOCHA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANOCHA
Provider First Name:
VIVEKANAND
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1992727200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6480 HARRISON AVE STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45247-7961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-354-3700
Provider Business Mailing Address Fax Number:
513-354-3705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7423 S MASON MONTGOMERY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-354-3700
Provider Business Practice Location Address Fax Number:
513-754-2014
Provider Enumeration Date:
07/24/2006

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: 208VP0014X , with the licence number:  35-087792 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20547559600 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2675850 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000513746 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2841465 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: $$$$$$$$$ . This is a "MMOH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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