Provider Demographics
NPI:1992727200
Name:MANOCHA, VIVEKANAND (MD)
Entity type:Individual
Prefix:DR
First Name:VIVEKANAND
Middle Name:
Last Name:MANOCHA
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 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-354-3700
Mailing Address - Fax:513-354-3705
Practice Address - Street 1:7423 S MASON MONTGOMERY ROAD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:513-354-3700
Practice Address - Fax:513-754-2014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-087792208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH20547559600OtherBWC
OH2675850Medicaid
OH000000513746OtherANTHEM
OH2841465Medicaid
OH$$$$$$$$$OtherMMOH
I58739Medicare UPIN
OH2841465Medicaid
OH2675850Medicaid