Individual
SUDHAKAR B. MANNAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
205 EASY ST STE 204, UNIONTOWN, PA 15401-3128
(724) 812-5580
(201) 812-5682
Mailing address
736 W INGOMAR RD UNIT 116, INGOMAR, PA 15127-6604
(201) 804-2800
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
MD426845
PA
208VP0000X
Pain Medicine Physician
Primary
MD426845
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101453513
—
PA
Enumeration date
12/07/2005
Last updated
03/05/2020
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