Provider Demographics
NPI:1588636195
Name:MANNAVA, VENKATA SIVANAGA PRASAD (MD)
Entity type:Individual
Prefix:MR
First Name:VENKATA
Middle Name:SIVANAGA PRASAD
Last Name:MANNAVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:155 MEMORIAL DRIVE
Mailing Address - Street 2:PO BOX 3000
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8710
Mailing Address - Country:US
Mailing Address - Phone:910-715-2164
Mailing Address - Fax:910-715-2173
Practice Address - Street 1:155 MEMORIAL DRIVE
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:910-715-2164
Practice Address - Fax:910-715-2173
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200501235207R00000X
NC2005-01235208M00000X
NC2005-10235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5657272OtherFIRST HEALTH
NC1400XOtherBCBS OF NC
NC183193OtherMEDCOST
NC7461708OtherAETNA
NCI41226Medicare UPIN
NC183193OtherMEDCOST