Provider Demographics
NPI:1750765244
Name:MUTHUKANAGARAJ, MANORANJAN (MD)
Entity type:Individual
Prefix:
First Name:MANORANJAN
Middle Name:
Last Name:MUTHUKANAGARAJ
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 1:1308 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3485
Mailing Address - Country:US
Mailing Address - Phone:252-946-3666
Mailing Address - Fax:252-975-8840
Practice Address - Street 1:1308 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3485
Practice Address - Country:US
Practice Address - Phone:252-946-3666
Practice Address - Fax:252-975-8840
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-03495207R00000X, 2084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine