Healthcare Provider Details

I. General information

NPI: 1972564631
Provider Name (Legal Business Name): MANU VACHHANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3729 EASTON NAZARETH HWY SUITE #101
EASTON PA
18045-8344
US

IV. Provider business mailing address

3729 EASTON NAZARETH HWY SUITE #101
EASTON PA
18045-8344
US

V. Phone/Fax

Practice location:
  • Phone: 610-253-1994
  • Fax: 610-253-8184
Mailing address:
  • Phone: 610-253-1994
  • Fax: 610-253-8184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number25MA05690300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD044703Y
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number25MA05690300
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA05690300
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD044703Y
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: