Healthcare Provider Details

I. General information

NPI: 1235558636
Provider Name (Legal Business Name): MANAS NIGAM B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 204
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR STE 204
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-5680
  • Fax:
Mailing address:
  • Phone: 757-388-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101273709
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number0101273709
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: