Provider Demographics
NPI:1609860618
Name:GEORGE, MANJU BABU (DO)
Entity Type:Individual
Prefix:DR
First Name:MANJU
Middle Name:BABU
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 HARBOR PASS DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3428
Mailing Address - Country:US
Mailing Address - Phone:832-259-6875
Mailing Address - Fax:
Practice Address - Street 1:1917 W GRAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-4801
Practice Address - Country:US
Practice Address - Phone:832-260-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9613207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179197203Medicaid
TX1609860618OtherBCBSTX
TX179197202Medicaid
TX8V1564OtherBCBS TX
TX1609860618OtherTRICARE SOUTH
TX1609860618OtherTRICARE SOUTH
P000402999Medicare PIN
TX8V1564OtherBCBS TX
TX8J8691Medicare PIN
TX1609860618Medicare PIN