Provider Demographics
NPI:1669905063
Name:MANIAR, VIRAJ (MD)
Entity type:Individual
Prefix:
First Name:VIRAJ
Middle Name:
Last Name:MANIAR
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 1:400 W 84TH DR
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6248
Mailing Address - Country:US
Mailing Address - Phone:219-276-9186
Mailing Address - Fax:
Practice Address - Street 1:400 W 84TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6248
Practice Address - Country:US
Practice Address - Phone:219-769-8641
Practice Address - Fax:219-769-2280
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01094296A208800000X
WI71170208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300093536Medicaid
WI1669905063Medicaid