Healthcare Provider Details

I. General information

NPI: 1962843292
Provider Name (Legal Business Name): MANISH BAJAJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 NEMOURS PKWY
ORLANDO FL
32827-7884
US

IV. Provider business mailing address

6535 NEMOURS PKWY
ORLANDO FL
32827-7884
US

V. Phone/Fax

Practice location:
  • Phone: 407-567-4000
  • Fax: 321-388-0162
Mailing address:
  • Phone: 404-785-6541
  • Fax: 404-785-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberME166050
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: