Provider Demographics
NPI:1255305397
Name:MANDAVA, KARUNA S (MD)
Entity Type:Individual
Prefix:
First Name:KARUNA
Middle Name:S
Last Name:MANDAVA
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 1:426 PELLIS RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4574
Mailing Address - Country:US
Mailing Address - Phone:724-838-0090
Mailing Address - Fax:724-830-7717
Practice Address - Street 1:426 PELLIS RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4574
Practice Address - Country:US
Practice Address - Phone:724-838-0090
Practice Address - Fax:724-830-7717
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072721L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH52420Medicare UPIN