Provider Demographics
NPI:1295725836
Name:MANOHAR, ASHAN (MD)
Entity type:Individual
Prefix:
First Name:ASHAN
Middle Name:
Last Name:MANOHAR
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 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:20486 MARKET STREET
Practice Address - Street 2:
Practice Address - City:ONANCOCK
Practice Address - State:VA
Practice Address - Zip Code:23417
Practice Address - Country:US
Practice Address - Phone:757-302-2700
Practice Address - Fax:757-787-9262
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037701207RG0100X
VA0101058609207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT037701OtherCONNECTICARE
CT0V6836OtherHEALTHNET NE
CT010037701CT01OtherANTHEM BCBS CT
CT2543604OtherAETNA HMO
CT7122039OtherAETNA PPO
CTP1992625OtherOXFORD
CTP1992625OtherOXFORD
CT010037701CT01OtherANTHEM BCBS CT
CTP1992625OtherOXFORD