Provider Demographics
NPI:1508982273
Name:CHENCHUGALLA, MANOHAR KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOHAR
Middle Name:KUMAR
Last Name:CHENCHUGALLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2700 HEALING WAY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-5453
Mailing Address - Country:US
Mailing Address - Phone:813-779-6303
Mailing Address - Fax:888-977-1998
Practice Address - Street 1:2700 HEALING WAY
Practice Address - Street 2:SUITE 320
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-5453
Practice Address - Country:US
Practice Address - Phone:813-779-6303
Practice Address - Fax:888-977-1998
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME114742208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD022479100Medicaid