MEDICARE: VREJ K MANOOGIAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	OS7528	FL
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	OS7528	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD9204	OTHER	FL	RAILROAD MEDICARE GROUP
3	200041567	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	46883	OTHER	FL	BLUE CROSS BLUE SHIELD FL

General Provider Information

NPI Number	:	1275529455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VREJ K MANOOGIAN D.O.

Provider Business Mailing Address
First Line	:	1945 BAY RD
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-2105
Country	:	US
Telephone Number	:	352-483-5633
Fax Number	:	352-483-5070

Provider Business Practice Location Address
First Line	:	1945 BAY RD
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-2105
Country	:	US
Telephone Number	:	352-483-5633
Fax Number	:	352-483-5070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	11/30/2007

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Directions to “ VREJ K MANOOGIAN D.O.” Practice Location

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