Provider Demographics
NPI:1407172448
Name:DEVIDI, MANJARI (MD)
Entity Type:Individual
Prefix:DR
First Name:MANJARI
Middle Name:
Last Name:DEVIDI
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 1:6431 FANNIN ST # 5.270
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:571-291-5278
Mailing Address - Fax:713-500-0580
Practice Address - Street 1:6410 FANNIN ST STE 450
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3008
Practice Address - Country:US
Practice Address - Phone:713-486-3100
Practice Address - Fax:713-512-2246
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR8175207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty