Provider Demographics
NPI:1972564631
Name:VACHHANI, MANU (MD)
Entity type:Individual
Prefix:DR
First Name:MANU
Middle Name:
Last Name:VACHHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3729 EASTON NAZARETH HWY
Mailing Address - Street 2:SUITE #101
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-8344
Mailing Address - Country:US
Mailing Address - Phone:610-253-1994
Mailing Address - Fax:610-253-8184
Practice Address - Street 1:3729 EASTON NAZARETH HWY
Practice Address - Street 2:SUITE #101
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8344
Practice Address - Country:US
Practice Address - Phone:610-253-1994
Practice Address - Fax:610-253-8184
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05690300207QA0505X, 207QG0300X, 207R00000X, 207R00000X
PAMD044703Y207QG0300X, 207R00000X, 207QG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA501915OtherAETNA
PA01042001OtherCAPITAL BLUE CROSS
PA232684415OtherHUMANA
PA02865400OtherKEYSTONE
PAG05393OtherAMERIHEALTH ADMIN
PA232684415OtherCIGNA HEALTHCARE
PA0012696450001Medicaid
PA1454853OtherHIGHMARK BLUE SHIELD
PA232684415OtherUNITED HEALTH CARE