Provider Demographics
NPI:1326073586
Name:MANCHIKALAPUDI, SRINIVASARAO (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVASARAO
Middle Name:
Last Name:MANCHIKALAPUDI
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 1:2109 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150
Mailing Address - Country:US
Mailing Address - Phone:812-948-2232
Mailing Address - Fax:812-945-0869
Practice Address - Street 1:2109 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150
Practice Address - Country:US
Practice Address - Phone:812-948-2232
Practice Address - Fax:812-945-0869
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053939A207RI0011X
KY32499207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200324770AMedicaid
KY64032402Medicaid
KY64032402Medicaid
KY0516704Medicare PIN
IN206200DMedicare PIN