Basic Information
| Provider Information | |||||||||
| NPI: | 1265786115 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIWARI | ||||||||
| FirstName: | MANISHA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 SAINT ANDREW ST | ||||||||
| Address2: | |||||||||
| City: | TARBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278863842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6464681166 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 101 CLINIC DR | ||||||||
| Address2: | |||||||||
| City: | TARBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278861935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124236771 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2012 | ||||||||
| LastUpdateDate: | 01/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2017-00245 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 932281217 | 01 | NY | GHI BLUE CROSS BLUE SHIELD | OTHER |