1003883992 NPI number — DR. ASHA V MANAKTALA MD

Table of content: SUSAN JOY KOHNKE APRN (NPI 1669462198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003883992 NPI number — DR. ASHA V MANAKTALA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANAKTALA
Provider First Name:
ASHA
Provider Middle Name:
V
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JHARERI
Provider Other First Name:
ASHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003883992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
345 NORTH MAIN ST
Provider Second Line Business Mailing Address:
SUITE 248
Provider Business Mailing Address City Name:
WEST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-213-8453
Provider Business Mailing Address Fax Number:
860-523-4061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820C PROSPECT HILL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDSOR
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-285-8251
Provider Business Practice Location Address Fax Number:
860-687-1774
Provider Enumeration Date:
03/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  024267 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04058400 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010024267CT02 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 020267 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com