Provider Demographics
NPI:1750762662
Name:NAGARATHNA G. MANJAPPA M.D. INC.
Entity type:Organization
Organization Name:NAGARATHNA G. MANJAPPA M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGARATHNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MANJAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-253-7005
Mailing Address - Street 1:3230 BEARD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3659
Mailing Address - Country:US
Mailing Address - Phone:707-253-7005
Mailing Address - Fax:707-253-7271
Practice Address - Street 1:3230 BEARD RD STE 1
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3659
Practice Address - Country:US
Practice Address - Phone:707-253-7005
Practice Address - Fax:707-253-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA162424Medicare PIN
CACA164178Medicare PIN