Provider Demographics
NPI:1003883992
Name:MANAKTALA, ASHA V (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHA
Middle Name:V
Last Name:MANAKTALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ASHA
Other - Middle Name:
Other - Last Name:JHARERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:345 NORTH MAIN ST
Mailing Address - Street 2:SUITE 248
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117
Mailing Address - Country:US
Mailing Address - Phone:860-213-8453
Mailing Address - Fax:860-523-4061
Practice Address - Street 1:820C PROSPECT HILL ROAD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095
Practice Address - Country:US
Practice Address - Phone:860-285-8251
Practice Address - Fax:860-687-1774
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0242672080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT04058400Medicaid
CT010024267CT02OtherANTHEM BCBS
CT020267OtherCONNECTICARE