Healthcare Provider Details

I. General information

NPI: 1265786115
Provider Name (Legal Business Name): MANISHA TIWARI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 01/20/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CLINIC DR
TARBORO NC
27886-1935
US

IV. Provider business mailing address

1005 SAINT ANDREW ST
TARBORO NC
27886-3842
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6771
  • Fax:
Mailing address:
  • Phone: 646-468-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017-00245
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: