Provider Demographics
NPI:1598733859
Name:MANKAD, NAISHADH AJITRAI (MD)
Entity Type:Individual
Prefix:DR
First Name:NAISHADH
Middle Name:AJITRAI
Last Name:MANKAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12127B HWY 14 N STE 5
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9557
Mailing Address - Country:US
Mailing Address - Phone:505-281-5180
Mailing Address - Fax:505-281-5320
Practice Address - Street 1:12127B HWY 14 N STE 5
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-9557
Practice Address - Country:US
Practice Address - Phone:505-281-2460
Practice Address - Fax:505-281-2463
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM98329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ0646Medicaid
NMZ0646Medicaid