Individual
MANOJ JAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
314 FRANKLIN AVE, BERLIN, MD 21811-1215
(410) 641-0277
(410) 641-9581
Mailing address
2234 COLONIAL BLVD, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
D60818
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010040493
—
VI
05
—
010040523
—
VI
05
—
010040825
—
VI
01
—
01219116
AMERIGROUP PROV. # (KATIN)
DE
05
—
1000024706
—
DE
01
—
10236764
AMERIGROUP PROV. # (BERLIN)
MD
05
—
403688300
—
MD
05
—
403688301
—
MD
Enumeration date
09/23/2005
Last updated
03/27/2009
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