Provider Demographics
NPI:1467563726
Name:MANIKTALA, ANITA (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:MANIKTALA
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 1:212 ASHVILLE AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511
Mailing Address - Country:US
Mailing Address - Phone:919-859-1136
Mailing Address - Fax:919-859-4240
Practice Address - Street 1:212 ASHVILLE AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511
Practice Address - Country:US
Practice Address - Phone:919-859-1136
Practice Address - Fax:919-859-4240
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701045208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
3131308OtherCIGNA PROVIDER AND GROUP
6600233OtherUNITED PROVIDER NUMBER
131HKOtherBCBS PROVIDER NUMBER
336395OtherMAMSI GROUP NUMBER
7441170OtherAETNA GROUP NUMBER
5476713OtherAETNA PROVIDER #
85268OtherMEDCOST PROVIDER NUMBER
NC89131HKMedicaid
011P3OtherBCBS GROUP NUMBER
NC89011P3Medicaid
97-01045OtherLICENSE