Provider Demographics
NPI:1477670644
Name:MANAIG, MELLANY P (MD)
Entity Type:Individual
Prefix:DR
First Name:MELLANY
Middle Name:P
Last Name:MANAIG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:401 W 2ND ST
Mailing Address - Street 2:226
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-5345
Mailing Address - Country:US
Mailing Address - Phone:775-784-1223
Mailing Address - Fax:775-327-2006
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:706
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-784-5975
Practice Address - Fax:775-784-3722
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV12507207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1477670644Medicaid
NV104806Medicare PIN