Individual
KANNAN MANICKAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6820 HOSPITAL DR, SUITE 210, BALTIMORE, MD 21237-4352
(410) 391-6131
(410) 391-6144
Mailing address
10200 GRAND CENTRAL AVE STE 220, OWINGS MILLS, MD 21117-4366
(410) 581-1600
(410) 581-1600
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01056563A
IN
Other
Enumeration date
07/29/2005
Last updated
05/30/2025
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