Provider Demographics
NPI:1437516861
Name:MANOCHA, PANKAJ (MD)
Entity Type:Individual
Prefix:
First Name:PANKAJ
Middle Name:
Last Name:MANOCHA
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 1:5314 MARYLAND WAY SUITE 110
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:844-291-4535
Mailing Address - Fax:615-866-3643
Practice Address - Street 1:5314 MARYLAND WAY SUITE 110
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:844-291-4535
Practice Address - Fax:615-866-3643
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
CO00631852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program