Provider Demographics
NPI:1760650246
Name:NAIK, MANJULA SHARADA (MD)
Entity Type:Individual
Prefix:
First Name:MANJULA
Middle Name:SHARADA
Last Name:NAIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 SPRINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2847
Mailing Address - Country:US
Mailing Address - Phone:610-524-3703
Mailing Address - Fax:610-524-5990
Practice Address - Street 1:860 SPRINGDALE DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341
Practice Address - Country:US
Practice Address - Phone:610-524-3703
Practice Address - Fax:610-524-5990
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432878208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102212470Medicaid
PA102212470Medicaid