Provider Demographics
NPI:1578859583
Name:MANNAVA, RAKESH (MD)
Entity Type:Individual
Prefix:
First Name:RAKESH
Middle Name:
Last Name:MANNAVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 E BROAD ST STE 1400
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3806
Mailing Address - Country:US
Mailing Address - Phone:614-228-7231
Mailing Address - Fax:
Practice Address - Street 1:471 E BROAD ST STE 1400
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-3806
Practice Address - Country:US
Practice Address - Phone:614-228-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011115962085R0202X
OH35.1304372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology