Provider Demographics
NPI:1891905287
Name:MANDHARE, VIJAYSINHA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYSINHA
Middle Name:
Last Name:MANDHARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VIJAY
Other - Middle Name:
Other - Last Name:MANDHARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3801 WAKE FOREST RD STE 210
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6864
Mailing Address - Country:US
Mailing Address - Phone:919-787-7246
Mailing Address - Fax:919-787-7247
Practice Address - Street 1:3801 WAKE FOREST RD STE 210
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6864
Practice Address - Country:US
Practice Address - Phone:919-787-7246
Practice Address - Fax:919-787-7247
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00275207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910579Medicaid
NCP00759335OtherRAILROAD MEDICARE
NCDP4614OtherRAILROAD MEDICARE GROUP PTAN
NC5910579Medicaid
NC6541080001Medicare NSC
NCI02147Medicare UPIN