Provider Demographics
NPI:1255511440
Name:HARIDAS, MANJUNATH (MD)
Entity type:Individual
Prefix:DR
First Name:MANJUNATH
Middle Name:
Last Name:HARIDAS
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 1:215 WOOD ST
Mailing Address - Street 2:RICHLAND SURGICAL ASSOCIATES
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2260
Mailing Address - Country:US
Mailing Address - Phone:419-522-2833
Mailing Address - Fax:
Practice Address - Street 1:215 WOOD ST
Practice Address - Street 2:RICHLAND SURGICAL ASSOCIATES
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2260
Practice Address - Country:US
Practice Address - Phone:419-522-2833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-099875208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery