Provider Demographics
NPI:1235345851
Name:GADANI, MANU R (MD)
Entity Type:Individual
Prefix:
First Name:MANU
Middle Name:R
Last Name:GADANI
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 1:5303 PLAZA DR
Mailing Address - Street 2:SUITE-101
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-7331
Mailing Address - Country:US
Mailing Address - Phone:804-458-2006
Mailing Address - Fax:804-458-3629
Practice Address - Street 1:5303 PLAZA DR
Practice Address - Street 2:SUITE-101
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-7331
Practice Address - Country:US
Practice Address - Phone:804-458-2006
Practice Address - Fax:804-458-3629
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010558OtherCIGNA
VA230297OtherBLUE SHIELD
VAC32269Medicare UPIN