Manjul Derasari M.D.,P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME54111 Issued in FL

Legal business name

MANJUL DERASARI M.D.,P.A.

Practice address

1912 E Busch Blvd
Tampa, FL 33612-8666

Phone

(813) 933-5900

Fax

(813) 935-9687

NPI assigned

Dec 8, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Manjul D Derasari, M.D.

Title

Medical Director

Phone

(813) 933-5900

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387411200000",
    "number": "1407915929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1912 E BUSCH BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336128666",
            "telephone_number": "813-933-5900",
            "fax_number": "813-935-9687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1912 E BUSCH BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336128666",
            "telephone_number": "813-933-5900",
            "fax_number": "813-935-9687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANJUL DERASARI M.D.,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2013-12-19",
        "status": "A",
        "authorized_official_last_name": "DERASARI",
        "authorized_official_first_name": "MANJUL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "813-933-5900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME54111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2720607",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS",
            "identifier": "11609",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "064751900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gordon Michael Maniere, CP
• Manifestations Worldwide Inc
• Jack Earl Maniscalco, MD
• Valerie Maniscalco
• Maryis Elena Manjarres
• Manlar, Inc.
• Brandon Manley, M.D.
• Brock Jacob Manley, MD
• Lindsay Meredith Manley, WHNP-BC
• Wilma Jeanette Manley, APRN

• Specialist in Tampa, FL
• Providers in Tampa, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.