Provider Demographics
NPI:1477583235
Name:MANNAVA, SUMALATHA (MD,)
Entity Type:Individual
Prefix:DR
First Name:SUMALATHA
Middle Name:
Last Name:MANNAVA
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 1:441 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4270
Mailing Address - Country:US
Mailing Address - Phone:732-332-0574
Mailing Address - Fax:
Practice Address - Street 1:441 BOULDER DR
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-4270
Practice Address - Country:US
Practice Address - Phone:732-332-0574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07699000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine