Provider Demographics
NPI:1720263239
Name:WUNNAVA, MANOJ BOBBY SUBBARAO (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:BOBBY SUBBARAO
Last Name:WUNNAVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MANOJ
Other - Middle Name:SUBBARAO
Other - Last Name:WUNNAVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5322 HIGHGATE DR STE 143
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6633
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5322 HIGHGATE DR STE 143
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:984-464-7972
Practice Address - Fax:919-591-0567
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00892207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine