Provider Demographics
NPI:1952470080
Name:MANSHARAMANI, NARESH G (MD)
Entity Type:Individual
Prefix:
First Name:NARESH
Middle Name:G
Last Name:MANSHARAMANI
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 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1030 PRESIDENT AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5923
Practice Address - Country:US
Practice Address - Phone:508-973-1780
Practice Address - Fax:508-973-0359
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10120207RC0200X
MA151129207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110061420AMedicaid
RINM30549Medicaid
RINM30549Medicaid
MAS400109526Medicare PIN
RINM30549Medicaid
MAEX9524Medicare PIN
RI29386-6OtherBCBS
MA69644OtherHARVARD PILGRIM
MAJ21485OtherBCBS
RI007056481Medicare ID - Type Unspecified
MA403184OtherTUFTS