Individual
MR. VENKATA SIVANAGA PRASAD MANNAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
155 MEMORIAL DRIVE, PINEHURST, NC 28374-8710
(910) 715-2164
(910) 715-2173
Mailing address
155 MEMORIAL DRIVE, PO BOX 3000, PINEHURST, NC 28374-8710
(910) 715-2164
(910) 715-2173
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2005-10235
NC
207R00000X
Internal Medicine Physician
200501235
NC
208M00000X
Hospitalist Physician
2005-01235
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1400X
BCBS OF NC
NC
01
—
183193
MEDCOST
NC
01
—
5657272
FIRST HEALTH
NC
01
—
7461708
AETNA
NC
Enumeration date
02/07/2006
Last updated
09/12/2024
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