Provider Demographics
NPI:1508867995
Name:MONGA, MANISH (MD)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:
Last Name:MONGA
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 1:20 MEDICAL PARK
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6390
Mailing Address - Country:US
Mailing Address - Phone:304-243-6442
Mailing Address - Fax:304-243-3715
Practice Address - Street 1:20 MEDICAL PARK
Practice Address - Street 2:SUITE 202
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6390
Practice Address - Country:US
Practice Address - Phone:304-243-6442
Practice Address - Fax:304-243-3715
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20832207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
20832OtherHEALTH PLAN OF UPPER OH V
WV3003156000Medicaid
WV55035705700OtherWV COMPENSATION
OH2332201Medicaid
H61007Medicare UPIN
WV7301801Medicare ID - Type Unspecified