Provider Demographics
NPI:1740416676
Name:MISHRA, MANORAMA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANORAMA
Middle Name:
Last Name:MISHRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MONA
Other - Middle Name:
Other - Last Name:MISHRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8301 FARROW RD.
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-3245
Mailing Address - Country:US
Mailing Address - Phone:803-935-6728
Mailing Address - Fax:803-935-5081
Practice Address - Street 1:8301 FARROW RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-3245
Practice Address - Country:US
Practice Address - Phone:803-935-6728
Practice Address - Fax:803-935-5081
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11487208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice