Provider Demographics
NPI:1952302044
Name:MANHAPRA, RADHIKA A (MD)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:A
Last Name:MANHAPRA
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 1:4509 WHITE CHAPEL DRIVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455
Mailing Address - Country:US
Mailing Address - Phone:757-460-4655
Mailing Address - Fax:
Practice Address - Street 1:HAMPTON VAMC 100 EMANCIPATION DRIVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-0001
Practice Address - Country:US
Practice Address - Phone:757-722-9961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069879207R00000X
VA0101252176208M00000X
VA01011252176207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI300207909OtherTAX ID
P00206767OtherPALMETTO MEDICARE
MI4692200Medicaid
MI300207909OtherTAX ID
P00206767OtherPALMETTO MEDICARE