Provider Demographics
NPI:1285610600
Name:GARG, MANOJ KUMAR (DO)
Entity type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:KUMAR
Last Name:GARG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10 DAVOL SQ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4754
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:900 WARREN AVE
Practice Address - Street 2:STE 100
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1430
Practice Address - Country:US
Practice Address - Phone:401-383-9662
Practice Address - Fax:401-383-6526
Is Sole Proprietor?:No
Enumeration Date:2005-12-17
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIDO 00528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7009041Medicaid
RI05-0483739OtherTAX ID
RI05-0483739OtherTAX ID
RIG87076Medicare UPIN
089021410Medicare ID - Type UnspecifiedGROUP NUMBER
RI7009041Medicaid
A25976OtherHARVARD PILGRIM HEALTH
RISF44121Medicaid
0102418OtherUNITED HEALTHCARE
3483299OtherCIGNA
030430940OtherHEALTH CARE VALUE MANAGEM
7553110OtherAETNA INDEMNITY
RI409828OtherBLUE CHIP
RIG87076Medicare UPIN
403502OtherTUFTS HEALTHCARE
RI27903OtherNHPRI PROVIDER