Provider Demographics
NPI:1649656331
Name:MANA MEDICAL GROUP LLC
Entity type:Organization
Organization Name:MANA MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AVINASH
Authorized Official - Middle Name:
Authorized Official - Last Name:BHANDARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-383-7703
Mailing Address - Street 1:150 EAST ROBINSON STREET
Mailing Address - Street 2:UNIT 1810
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801
Mailing Address - Country:US
Mailing Address - Phone:860-216-7856
Mailing Address - Fax:
Practice Address - Street 1:1502 N DONNELLY ST STE 107
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2846
Practice Address - Country:US
Practice Address - Phone:407-605-5621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114143208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGQ846ZMedicare PIN