Provider Demographics
NPI:1437539640
Name:MANICKAVASAGAN, HANISHA RAJLAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:HANISHA
Middle Name:RAJLAKSHMI
Last Name:MANICKAVASAGAN
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-376-1180
Mailing Address - Fax:
Practice Address - Street 1:954 ISABEL DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7482
Practice Address - Country:US
Practice Address - Phone:717-376-1180
Practice Address - Fax:717-273-6937
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101281309207RG0100X
PAMT208935207R00000X
PAMD474258207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty