Provider Demographics
NPI:1679821516
Name:POONAM MANASA, M.D. P.A.
Entity Type:Organization
Organization Name:POONAM MANASA, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POONAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANASA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-560-0522
Mailing Address - Street 1:3238 OLD COACH DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2665
Mailing Address - Country:US
Mailing Address - Phone:727-560-0522
Mailing Address - Fax:
Practice Address - Street 1:2041 SUNDANCE PKWY
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2779
Practice Address - Country:US
Practice Address - Phone:727-560-0522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty