Provider Demographics
NPI:1255398962
Name:VANAPALLI, RAJU MANGA (MD)
Entity type:Individual
Prefix:DR
First Name:RAJU
Middle Name:MANGA
Last Name:VANAPALLI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1115 MOUNT ZION RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2266
Mailing Address - Country:US
Mailing Address - Phone:770-968-7421
Mailing Address - Fax:770-960-0078
Practice Address - Street 1:1115 MOUNT ZION RD
Practice Address - Street 2:SUITE J
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2266
Practice Address - Country:US
Practice Address - Phone:770-968-7421
Practice Address - Fax:770-960-0078
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2007-10-10
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Provider Licenses
StateLicense IDTaxonomies
GA22656207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D31082Medicare UPIN
FL20NCCSDMedicare PIN