Provider Demographics
NPI:1962486357
Name:KAVURU, MANI S (MD)
Entity Type:Individual
Prefix:DR
First Name:MANI
Middle Name:S
Last Name:KAVURU
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 1:834 WALNUT ST
Mailing Address - Street 2:SUITE 650
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:834 WALNUT ST
Practice Address - Street 2:SUITE 650
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-955-5161
Practice Address - Fax:215-923-6003
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501043207RC0200X, 207RP1001X
PAMD440719207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0243621Medicaid
PA001567629Medicaid
NC140P4OtherBCBS NC
NC5901907Medicaid
NCE77760Medicare UPIN
NC2046248Medicare ID - Type Unspecified
NC5901907Medicaid