Provider Demographics
NPI:1164442778
Name:MANOHAR, NASHIN (DO)
Entity Type:Individual
Prefix:
First Name:NASHIN
Middle Name:
Last Name:MANOHAR
Suffix:
Gender:M
Credentials:DO
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 3569
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-3569
Mailing Address - Country:US
Mailing Address - Phone:956-627-3151
Mailing Address - Fax:956-627-3145
Practice Address - Street 1:2123 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8301
Practice Address - Country:US
Practice Address - Phone:956-627-3151
Practice Address - Fax:956-627-3145
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8122208100000X, 2081P2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170077502Medicaid
TXH20777Medicare UPIN
TX170077501Medicaid