Healthcare Provider Details

I. General information

NPI: 1144232166
Provider Name (Legal Business Name): MANANYA MALLIKAMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14999 HEALTH CENTER DR
BOWIE MD
20716-1074
US

IV. Provider business mailing address

PO BOX 6687
ANNAPOLIS MD
21401-0687
US

V. Phone/Fax

Practice location:
  • Phone: 443-332-4088
  • Fax: 410-793-0809
Mailing address:
  • Phone: 410-263-6638
  • Fax: 410-268-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD23393
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: