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Organization
MANOHAR VAJJA, MD PA
Active
Organization
MANOHAR VAJJA, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANOHAR PRASAD VAJJA MD (PRESIDENT)
(972) 910-9341
Entity
Organization
Contact information
Practice address
6447 MALAGA, IRVING, TX 75039-3191
(972) 910-9341
(972) 499-2500
Mailing address
6447 MALAGA, IRVING, TX 75039-3191
(972) 910-9341
(972) 499-2500
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M7714
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M7714
LICENCE
TX
01
—
TXB130027
MEDICARE PART B
TX
Enumeration date
05/03/2011
Last updated
09/09/2011
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