Individual
MANASA DEVI VALLABHANENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3322 N BROAD ST, PHILADELPHIA, PA 19140-5185
(215) 707-1800
Mailing address
3222 N BROAD ST, PHILADELPHIA, PA 19140-5008
(215) 707-1800
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MT228724
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT228724
PALS
PA
Enumeration date
05/31/2023
Last updated
10/02/2023
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