Provider Demographics
NPI:1275553315
Name:PATEL, MANISHA T (MD)
Entity Type:Individual
Prefix:
First Name:MANISHA
Middle Name:T
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:200 PARK AT NORTH HILLS ST STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-2658
Practice Address - Country:US
Practice Address - Phone:888-663-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209897207Q00000X
NY255583207Q00000X
PAMD072672L207Q00000X
NJ25MA08161500207Q00000X
NC202102093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0148725Medicaid
MA000000033267OtherBMC HEALTHNET
MA209897OtherTUFTS
413307OtherRI BLUE CHIP
MAAA59391OtherHPHC
MA0237449OtherCIGNA
MAJ24034OtherMABC
MAJ24034OtherMABC
MAH49091Medicare UPIN