Provider Demographics
NPI:1164451621
Name:MANEKSHA, JIMMY R (MD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:R
Last Name:MANEKSHA
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 260
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03748-0260
Mailing Address - Country:US
Mailing Address - Phone:603-632-9270
Mailing Address - Fax:
Practice Address - Street 1:125 MASCOMA STREET
Practice Address - Street 2:ALICE PECK DAY MEMORIAL HOSPITAL
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766
Practice Address - Country:US
Practice Address - Phone:603-448-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8909208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0RE2591Medicaid
NH30005716Medicaid
NH30005716Medicaid