Provider Demographics
NPI:1801993910
Name:JASROTIA, MANAV (MD)
Entity type:Individual
Prefix:DR
First Name:MANAV
Middle Name:
Last Name:JASROTIA
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 1:1325 N LITCHFIELD RD STE 110
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1214
Mailing Address - Country:US
Mailing Address - Phone:623-935-9494
Mailing Address - Fax:623-935-9292
Practice Address - Street 1:1325 N LITCHFIELD RD STE 110
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1214
Practice Address - Country:US
Practice Address - Phone:623-935-9494
Practice Address - Fax:623-935-9292
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1801993910OtherBC/BS OF AZ
TXP00378917OtherRR MEDICARE
AZ163235Medicaid
TX8V1927OtherBCBS
TX8F4475Medicare PIN
AZ116805Medicare PIN
TX124906Medicare UPIN
TX8V1927OtherBCBS
AZ1801993910OtherBC/BS OF AZ
AZ116806Medicare PIN