Provider Demographics
NPI:1487846507
Name:PATWARDHAN, MANASI SANJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MANASI
Middle Name:SANJAY
Last Name:PATWARDHAN
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 1:295A MIDLAND PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5901
Mailing Address - Country:US
Mailing Address - Phone:843-851-3800
Mailing Address - Fax:843-851-7787
Practice Address - Street 1:4201 SAINT ANTOINE ST STE 4C
Practice Address - Street 2:UNIVERSITY HEALTH CENTER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-745-4399
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81814207V00000X, 207VM0101X
MI4301097751207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology