Healthcare Provider Details

I. General information

NPI: 1821035650
Provider Name (Legal Business Name): MANISH GARG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 LIMESTONE RD SUITE 7
WILMINGTON DE
19808-5553
US

IV. Provider business mailing address

2006 LIMESTONE RD SUITE 7
WILMINGTON DE
19808-5553
US

V. Phone/Fax

Practice location:
  • Phone: 302-355-2383
  • Fax: 302-351-6261
Mailing address:
  • Phone: 302-355-2383
  • Fax: 302-351-6261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC10007344
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberC10007344
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: