Provider Demographics
NPI:1518078831
Name:MANNE, RAJA SEKHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJA
Middle Name:SEKHAR
Last Name:MANNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD SPRINGS
Mailing Address - State:CT
Mailing Address - Zip Code:06076-4005
Mailing Address - Country:US
Mailing Address - Phone:860-684-4251
Mailing Address - Fax:860-684-8165
Practice Address - Street 1:71 HAYNES ST STE 1209
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4131
Practice Address - Country:US
Practice Address - Phone:860-533-6595
Practice Address - Fax:860-533-6594
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045540207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001455402Medicaid
CT110010327OtherMEDICARE PTAN