Provider Demographics
NPI:1659398543
Name:MANCHERJE, CYRUS R (MD)
Entity Type:Individual
Prefix:
First Name:CYRUS
Middle Name:R
Last Name:MANCHERJE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5055 BUSINESS CENTER DR
Mailing Address - Street 2:108 BOX 185
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1643
Mailing Address - Country:US
Mailing Address - Phone:415-609-8513
Mailing Address - Fax:707-689-5639
Practice Address - Street 1:1860 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3590
Practice Address - Country:US
Practice Address - Phone:415-609-8513
Practice Address - Fax:707-689-5639
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2014-11-24
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Provider Licenses
StateLicense IDTaxonomies
CAA41743207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A17430Medicare PIN
A29451Medicare UPIN