Provider Demographics
NPI:1861428989
Name:MANCHANDA, VIVEK (MD)
Entity type:Individual
Prefix:
First Name:VIVEK
Middle Name:
Last Name:MANCHANDA
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 1:1959 NE PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:206-520-5700
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-4746
Practice Address - Country:US
Practice Address - Phone:206-520-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000439262085N0904X, 2085R0202X
IDM-123142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1861428989Medicaid
WA8459877Medicaid
ID1861428989Medicaid
WA280292OtherLNI PROVIDER ID
WA280313OtherLNI PROVIDER ID
WA280293OtherLNI PROVIDER ID
WA280317OtherLNI PROVIDER ID
WA280293OtherLNI PROVIDER ID
WAG8905129Medicare PIN
WAH29948Medicare UPIN
ID20004576Medicare PIN
WA280317OtherLNI PROVIDER ID
WA280292OtherLNI PROVIDER ID
WA1046523Medicaid
WA8459877Medicaid