Provider Demographics
NPI:1952574840
Name:MANICKAM, SAVITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAVITHA
Middle Name:
Last Name:MANICKAM
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 1:14955 SHADY GROVE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8728
Mailing Address - Country:US
Mailing Address - Phone:301-990-3190
Mailing Address - Fax:
Practice Address - Street 1:14955 SHADY GROVE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8728
Practice Address - Country:US
Practice Address - Phone:301-990-3190
Practice Address - Fax:401-367-2021
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234842207Q00000X
MDD79319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2155753Medicaid
MA2155753Medicaid