Provider Demographics
NPI:1558315101
Name:AILAWADI, MANEESH (MD)
Entity Type:Individual
Prefix:
First Name:MANEESH
Middle Name:
Last Name:AILAWADI
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 1:59 SURREY DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-3143
Mailing Address - Country:US
Mailing Address - Phone:484-955-4660
Mailing Address - Fax:844-570-2273
Practice Address - Street 1:2200 HAMILTON ST STE 111
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6329
Practice Address - Country:US
Practice Address - Phone:484-934-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4287822086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1839560OtherHIGHMARK BLUE SHIELD
PA1016419700005Medicaid
I52425Medicare UPIN