Provider Demographics
NPI:1912638172
Name:RAJAMANURI, MEDHA (MD)
Entity Type:Individual
Prefix:MS
First Name:MEDHA
Middle Name:
Last Name:RAJAMANURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 STAUNTON AVE SE, APT 18
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:754-277-9866
Mailing Address - Fax:
Practice Address - Street 1:751 N RUTLEDGE ST # 1100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4968
Practice Address - Country:US
Practice Address - Phone:217-535-8000
Practice Address - Fax:217-545-8000
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program