Provider Demographics
NPI:1063463099
Name:MANN, DHARAM PAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DHARAM
Middle Name:PAL
Last Name:MANN
Suffix:
Gender:M
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:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-0397
Mailing Address - Country:US
Mailing Address - Phone:732-849-0077
Mailing Address - Fax:732-849-0015
Practice Address - Street 1:1100 ROUTE 70
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-1003
Practice Address - Country:US
Practice Address - Phone:732-849-0077
Practice Address - Fax:732-849-0015
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25MA07706000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5930060001OtherDME
NJP00328356Medicare PIN
NJ5930060001OtherDME
NJ088474Medicare PIN