Provider Demographics
NPI:1467441378
Name:NACHIYAPPAN, MANOHARAN (MD)
Entity Type:Individual
Prefix:
First Name:MANOHARAN
Middle Name:
Last Name:NACHIYAPPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NACHIYAPPAN
Other - Middle Name:
Other - Last Name:MANOHARAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2828
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-2828
Mailing Address - Country:US
Mailing Address - Phone:860-585-3906
Mailing Address - Fax:860-585-3907
Practice Address - Street 1:10 N MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-8122
Practice Address - Country:US
Practice Address - Phone:860-314-2052
Practice Address - Fax:860-314-2054
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0187522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001187525Medicaid
E51464Medicare UPIN
CT260003258Medicare ID - Type Unspecified