Healthcare Provider Details

I. General information

NPI: 1760650246
Provider Name (Legal Business Name): MANJULA SHARADA NAIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 SPRINGDALE DR
EXTON PA
19341
US

IV. Provider business mailing address

860 SPRINGDALE DR
EXTON PA
19341-2847
US

V. Phone/Fax

Practice location:
  • Phone: 610-524-3703
  • Fax: 610-524-5990
Mailing address:
  • Phone: 610-524-3703
  • Fax: 610-524-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD432878
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD432878
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: