Provider Demographics
NPI:1851376354
Name:WADHWA, MANISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANISHA
Middle Name:
Last Name:WADHWA
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 1:5189 W WOODMILL DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4009
Mailing Address - Country:US
Mailing Address - Phone:302-633-6001
Mailing Address - Fax:302-295-6289
Practice Address - Street 1:5189 W WOODMILL DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4009
Practice Address - Country:US
Practice Address - Phone:302-633-6001
Practice Address - Fax:302-295-6289
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00076932084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000036971Medicaid
DEI43010Medicare UPIN
DE1000036971Medicaid