Provider Demographics
NPI:1790185486
Name:MANNA, JOSEPH
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:MANNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 APPLE BLOSSOM CT
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-5402
Mailing Address - Country:US
Mailing Address - Phone:703-423-9021
Mailing Address - Fax:
Practice Address - Street 1:SHEIKH KHALIFA MEDICAL CITY
Practice Address - Street 2:
Practice Address - City:ABU DHABI
Practice Address - State:ABU DHABI
Practice Address - Zip Code:767978
Practice Address - Country:AE
Practice Address - Phone:97150-448-2206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDO31671207P00000X
MDH0054848207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300086825Medicaid