Provider Demographics
NPI:1710141767
Name:RODA, MANOHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOHAR
Middle Name:
Last Name:RODA
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 1:20 YORK ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-688-2433
Mailing Address - Fax:203-688-9258
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2433
Practice Address - Fax:203-688-9258
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS229412085R0202X
MA2357702085R0202X
MS741-L2085R0202X
CT741842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL158727Medicaid
MS03805202Medicaid
MS302I301393Medicare PIN
AL158727Medicaid
MS333240YWZ1Medicare PIN