Provider Demographics
NPI:1205847944
Name:RUNGTA, MANISH (MD)
Entity Type:Individual
Prefix:DR
First Name:MANISH
Middle Name:
Last Name:RUNGTA
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 1:1015 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77589-4011
Mailing Address - Country:US
Mailing Address - Phone:281-480-6264
Mailing Address - Fax:281-480-4046
Practice Address - Street 1:1015 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 1700
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77589-4011
Practice Address - Country:US
Practice Address - Phone:281-480-6264
Practice Address - Fax:281-480-4046
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4686207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7518588OtherAETNA PROVIDER NUMBER
TX10016744OtherAMERIGROUP
TX8K6291OtherBCBS PROVIDER NUMBER
TX167491301Medicaid
TX23266OtherMHHNP
TXI16518Medicare UPIN
TX8L14344Medicare PIN
TX8K6291OtherBCBS PROVIDER NUMBER
TXP00167975Medicare PIN