Provider Demographics
NPI:1730130006
Name:NERKAR, MANISHA SANDIP (MD)
Entity Type:Individual
Prefix:
First Name:MANISHA
Middle Name:SANDIP
Last Name:NERKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 W THUNDERBIRD RD STE F1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4652
Mailing Address - Country:US
Mailing Address - Phone:888-698-6727
Mailing Address - Fax:
Practice Address - Street 1:5620 W THUNDERBIRD RD STE F1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4652
Practice Address - Country:US
Practice Address - Phone:888-698-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037077207QG0300X, 207R00000X
AZ45362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8242984Medicaid
WA8242984Medicaid
8857995Medicare ID - Type Unspecified
WAG8891274Medicare PIN
WAG98316Medicare UPIN
WAG8886500Medicare PIN