Provider Demographics
NPI:1225126600
Name:RAJAMANICKAM, ANITHA (MD)
Entity Type:Individual
Prefix:
First Name:ANITHA
Middle Name:
Last Name:RAJAMANICKAM
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 1:3907 WARING RD STE 3
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4454
Mailing Address - Country:US
Mailing Address - Phone:917-297-4634
Mailing Address - Fax:760-450-9655
Practice Address - Street 1:3907 WARING RD STE 3
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4454
Practice Address - Country:US
Practice Address - Phone:917-297-4634
Practice Address - Fax:760-450-9655
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086070207R00000X
CA137462207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2576814Medicaid
OH2576814Medicaid
OHI32390Medicare UPIN