Provider Demographics
NPI:1114129418
Name:MANAWADU, BINGUMAL RANJITH (MD)
Entity Type:Individual
Prefix:DR
First Name:BINGUMAL
Middle Name:RANJITH
Last Name:MANAWADU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1408
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-1408
Mailing Address - Country:US
Mailing Address - Phone:509-946-3340
Mailing Address - Fax:509-943-7909
Practice Address - Street 1:1075 JADWIN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3437
Practice Address - Country:US
Practice Address - Phone:509-946-3340
Practice Address - Fax:509-943-7909
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018892207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1731801Medicaid
WA1731801Medicaid
WA000317291Medicare ID - Type UnspecifiedMEDICARE