Provider Demographics
NPI:1316007750
Name:JAIN, MANISH (MD)
Entity Type:Individual
Prefix:DR
First Name:MANISH
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:WEST END MEDICAL CENTER
Practice Address - Street 2:2100 W PENNSYLVANIA AVE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-4236
Practice Address - Country:US
Practice Address - Phone:202-872-7000
Practice Address - Fax:202-872-7133
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101236761207R00000X
DCMD33903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
016975K92Medicare ID - Type Unspecified
H80518Medicare UPIN