Provider Demographics
NPI:1730174020
Name:JARIWALA, MANISHA J (MD)
Entity type:Individual
Prefix:
First Name:MANISHA
Middle Name:J
Last Name:JARIWALA
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:13950 BRANDYWINE RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5815
Mailing Address - Country:US
Mailing Address - Phone:301-782-2220
Mailing Address - Fax:301-782-2221
Practice Address - Street 1:6710 OXON HILL RD STE 200B
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1124
Practice Address - Country:US
Practice Address - Phone:301-373-7900
Practice Address - Fax:301-373-6900
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2022-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0057999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD722200900Medicaid
MDH56222Medicare UPIN
MDB776OtherCAREFIRST DC GROUP NUMBER
DC624316OtherMEDICARE DC GROUP NUMBER
MDKR10MEOtherCAREFIRST MD GROUP NUMBER