Provider Demographics
NPI:1164596532
Name:MANOHARAN, UMAVATHY (MD)
Entity Type:Individual
Prefix:
First Name:UMAVATHY
Middle Name:
Last Name:MANOHARAN
Suffix:
Gender:F
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 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-8800
Mailing Address - Fax:
Practice Address - Street 1:810 W HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-8602
Practice Address - Country:US
Practice Address - Phone:830-201-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48430207R00000X
TXQ0312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
14172OtherDEAN HEALTH PLAN
67925569OtherIL PUBLIC AID
67925569OtherTRICARE
2016377OtherPHYSICIANS PLUS
390808509DVOtherUNITY
67925569003OtherBCBS
37925569003OtherBCBS MEDICARE SUPPLEMENT
I42557Medicare UPIN