Provider Demographics
NPI:1205945763
Name:MANOOGIAN ORTHOPEDIC CENTER, P.A.
Entity type:Organization
Organization Name:MANOOGIAN ORTHOPEDIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VREJ
Authorized Official - Middle Name:K
Authorized Official - Last Name:MANOOGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-483-5633
Mailing Address - Street 1:1945 BAY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2105
Mailing Address - Country:US
Mailing Address - Phone:352-483-5633
Mailing Address - Fax:352-483-5070
Practice Address - Street 1:1945 BAY RD
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757
Practice Address - Country:US
Practice Address - Phone:352-483-5633
Practice Address - Fax:352-483-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00260225OtherRAILROAD MEDICARE GURU
FLDD9204OtherRAILROAD MEDICARE GROUP
FL16714OtherBCBSFL SAMIR GURU, D.O.
FL200041567OtherRAILROAD MEDICARE MANOOGI
FL46883OtherBCBSFL VREJ MANOOGIAN, D.
FL94957OtherBCBSFL GROUP
FL94957OtherBCBSFL GROUP
FL16714OtherBCBSFL SAMIR GURU, D.O.
FLP00260225OtherRAILROAD MEDICARE GURU