Individual
DR. MANASA G MANTRAVADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
654 N SENATE AVE, INDIANAPOLIS, IN 46202-3110
(812) 240-9789
Mailing address
654 N SENATE AVE, INDIANAPOLIS, IN 46202-3110
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01075610A
IN
208000000X
Pediatrics Physician
ME113007
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201316090
—
IN
01
—
P01512486
MEDICARE RR PTAN
IN
Enumeration date
03/30/2009
Last updated
03/20/2017
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