Provider Demographics
NPI:1235182106
Name:MASSAND, MANOJ G (MD)
Entity type:Individual
Prefix:
First Name:MANOJ
Middle Name:G
Last Name:MASSAND
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:PO BOX 44037
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-4037
Mailing Address - Country:US
Mailing Address - Phone:602-954-6228
Mailing Address - Fax:602-957-6142
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4496
Practice Address - Country:US
Practice Address - Phone:602-954-6228
Practice Address - Fax:602-957-6142
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL11302085R0202X
NE258112085R0202X
GA838772085R0202X
CO492292085R0202X
AZ312152085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1235182106Medicaid
NV1235182106Medicaid
TX176590106Medicaid
OK200174100AMedicaid
SD1235182106Medicaid
TX176590102Medicaid
TX176590103Medicaid
NM74634241Medicaid
TX176590101Medicaid
TX176590104Medicaid
CO72750324Medicaid
NM74634241Medicaid
TX8D5068Medicare PIN
TX8D9443Medicare PIN
TX176590101Medicaid
TX176590104Medicaid
NENA1215064Medicare PIN
NENA1214064Medicare PIN