Provider Demographics
NPI:1497751143
Name:FOZDAR, MANISH AMRISH (MD)
Entity Type:Individual
Prefix:DR
First Name:MANISH
Middle Name:AMRISH
Last Name:FOZDAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1109 CHILMARK AVE
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5334
Mailing Address - Country:US
Mailing Address - Phone:919-322-1954
Mailing Address - Fax:919-322-1955
Practice Address - Street 1:4700 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6200
Practice Address - Country:US
Practice Address - Phone:919-322-1954
Practice Address - Fax:919-322-1955
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2013-08-19
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Provider Licenses
StateLicense IDTaxonomies
NC98005352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F34487Medicare UPIN