Provider Demographics
NPI:1881799146
Name:NATH, MANOJ (MD)
Entity type:Individual
Prefix:
First Name:MANOJ
Middle Name:
Last Name:NATH
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 1:1800 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2386
Mailing Address - Country:US
Mailing Address - Phone:702-207-8263
Mailing Address - Fax:702-304-2147
Practice Address - Street 1:1800 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2386
Practice Address - Country:US
Practice Address - Phone:702-207-8263
Practice Address - Fax:702-304-2147
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8705207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018081Medicaid
NV1881799146Medicaid
NVV31709Medicare ID - Type UnspecifiedMCRE INDIVIDUAL
NV002018081Medicaid
NVV31708Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER