Healthcare Provider Details

I. General information

NPI: 1720110133
Provider Name (Legal Business Name): MANJULA KARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 KNOLL NORTH DR STE 300
COLUMBIA MD
21045-2369
US

IV. Provider business mailing address

5450 KNOLL NORTH DR STE 300
COLUMBIA MD
21045-2369
US

V. Phone/Fax

Practice location:
  • Phone: 410-964-6300
  • Fax:
Mailing address:
  • Phone: 410-964-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0069093
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC7-0003526
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: