Provider Demographics
NPI:1235182106
Name:MASSAND, MANOJ G (MD)
Entity Type:Individual
Prefix:
First Name:MANOJ
Middle Name:G
Last Name:MASSAND
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 1:9500 EUCLID AVE # L-10
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-6431
Mailing Address - Fax:216-636-5030
Practice Address - Street 1:9500 EUCLID AVE # L-10
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-6431
Practice Address - Fax:216-636-5030
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL11302085R0202X
NE258112085R0202X
GA838772085R0202X
CO492292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200174100AMedicaid
TX176590102Medicaid
TX176590103Medicaid
TX176590104Medicaid
CA1235182106Medicaid
SD1235182106Medicaid
TX176590101Medicaid
NV1235182106Medicaid
TX176590106Medicaid
CO72750324Medicaid
NM74634241Medicaid
NM74634241Medicaid
TX8D5068Medicare PIN
TX8D9443Medicare PIN
TX176590101Medicaid
TX176590104Medicaid
NENA1215064Medicare PIN
NENA1214064Medicare PIN