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Individual

DR. MANASA G MANTRAVADI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

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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