Provider Demographics
NPI:1972576569
Name:MANAVALAN, PIUS (MD)
Entity Type:Individual
Prefix:
First Name:PIUS
Middle Name:
Last Name:MANAVALAN
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 1:3090 MCBRIDE CT, SUITE B
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011
Mailing Address - Country:US
Mailing Address - Phone:513-863-8212
Mailing Address - Fax:513-863-8379
Practice Address - Street 1:3090 MCBRIDE CT, SUITE B
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011
Practice Address - Country:US
Practice Address - Phone:513-863-8212
Practice Address - Fax:513-863-8379
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-0215M207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2288171Medicaid
OH2288171Medicaid
OH4066021Medicare PIN