Individual
DR. DEVARAJAN JYOTHISH MANU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 ATWELL RD, COOPERSTOWN, NY 13326-1301
(607) 547-6543
(607) 547-3259
Mailing address
1 ATWELL RD, COOPERSTOWN, NY 13326-1301
(607) 547-6543
(607) 547-3259
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
018645
ME
207R00000X
Internal Medicine Physician
Primary
282099
NY
207R00000X
Internal Medicine Physician
4301104920
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
282099
NEW YORK STATE LICENSE
NY
01
—
4301104920
LICENSE
MI
Enumeration date
05/31/2007
Last updated
11/06/2015
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