Provider Demographics
NPI:1326377284
Name:MANECKSHANA, BEJON TEMUS (MD)
Entity Type:Individual
Prefix:DR
First Name:BEJON
Middle Name:TEMUS
Last Name:MANECKSHANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-0366
Mailing Address - Country:US
Mailing Address - Phone:413-733-0010
Mailing Address - Fax:413-205-2807
Practice Address - Street 1:208 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1353
Practice Address - Country:US
Practice Address - Phone:413-747-1817
Practice Address - Fax:413-205-2807
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.121021204F00000X, 208600000X
CT055397204F00000X, 208600000X
NV14248204F00000X, 2086S0129X
MA283546208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVGA547ZMedicare PIN