Provider Demographics
NPI:1952309049
Name:VEERABAGU, MANJAKKOLLAI P (MD)
Entity Type:Individual
Prefix:
First Name:MANJAKKOLLAI
Middle Name:P
Last Name:VEERABAGU
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:PO BOX 3639
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-3639
Mailing Address - Country:US
Mailing Address - Phone:864-224-8689
Mailing Address - Fax:864-222-1303
Practice Address - Street 1:130 PERPETUAL SQ
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1713
Practice Address - Country:US
Practice Address - Phone:864-224-8689
Practice Address - Fax:864-222-1303
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20-18679207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT25149Medicaid
F03874Medicare UPIN
SCF038747749Medicare PIN