Provider Demographics
NPI:1588636195
Name:MANNAVA, VENKATA SIVA NAGA PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:SIVA NAGA PRASAD
Last Name:MANNAVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:155 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8710
Mailing Address - Country:US
Mailing Address - Phone:910-715-2288
Mailing Address - Fax:910-715-2173
Practice Address - Street 1:155 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8710
Practice Address - Country:US
Practice Address - Phone:910-715-2288
Practice Address - Fax:910-715-2173
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501235207R00000X
IL036.142986207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1400XOtherBCBS OF NC
NC5657272OtherFIRST HEALTH
NC7461708OtherAETNA
NC183193OtherMEDCOST
NCI41226Medicare UPIN
NC183193OtherMEDCOST