MEDICARE: CYRUS R. MANCHERJE, M.D., INC.

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	261QM2500X	Medical Specialty Clinic/Center	A41743	CA

General Provider Information

NPI Number	:	1447642723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYRUS R. MANCHERJE, M.D., INC.

Provider Business Mailing Address
First Line	:	5055 BUSINESS CENTER DR STE 185
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-1643
Country	:	US
Telephone Number	:	415-609-8513
Fax Number	:	707-689-5639

Provider Business Practice Location Address
First Line	:	1860 PENNSYLVANIA AVE STE 120
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-3550
Country	:	US
Telephone Number	:	707-646-4400
Fax Number	:	707-646-4401

Authorized Official
Title or Position	:	BILLING ACCOUNT MANAGER
Name	:	MS. MARION COOPER
Credential	:
Telephone Number	:	415-609-8513

Provider Enumeration Date	:	02/24/2015
Last Update Date	:	02/24/2015

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