Provider Demographics
NPI:1396199709
Name:SRIDHAR, MANASA M (DO)
Entity Type:Individual
Prefix:DR
First Name:MANASA
Middle Name:M
Last Name:SRIDHAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2671 AVENIR PL # B
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-7485
Mailing Address - Country:US
Mailing Address - Phone:703-207-8600
Mailing Address - Fax:
Practice Address - Street 1:2671B AVENIR PL
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-7176
Practice Address - Country:US
Practice Address - Phone:703-207-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102205714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine