Provider Demographics
NPI:1922064963
Name:DIXIT, MANJUL S (MD)
Entity Type:Individual
Prefix:
First Name:MANJUL
Middle Name:S
Last Name:DIXIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3301 EL CAMINO REAL
Mailing Address - Street 2:STE 101
Mailing Address - City:ATHERTON
Mailing Address - State:CA
Mailing Address - Zip Code:94027-3812
Mailing Address - Country:US
Mailing Address - Phone:650-556-9577
Mailing Address - Fax:650-556-0655
Practice Address - Street 1:3301 EL CAMINO REAL
Practice Address - Street 2:STE 101
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-3812
Practice Address - Country:US
Practice Address - Phone:650-556-9577
Practice Address - Fax:650-556-0655
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG84174207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MMM00087MOtherNHIC
MMM00087MOtherNHIC
MMM00087MOtherNHIC