Provider Demographics
NPI:1821150574
Name:WAIKAR, MANOJ V (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:V
Last Name:WAIKAR
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 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6940
Mailing Address - Country:US
Mailing Address - Phone:408-402-5240
Mailing Address - Fax:408-402-5383
Practice Address - Street 1:20 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030
Practice Address - Country:US
Practice Address - Phone:408-402-5240
Practice Address - Fax:408-402-5383
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A6933802084P0800X
CAA693382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI10072Medicare ID - Type Unspecified