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General NPI Number Information
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NPI Number | 1366722191
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Entity Type | Individual
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Provider Name | MANJU BENGALURU JAYANNA MBBS
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Gender | Male
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 08/10/2025
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Provider Practice Location Address
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Address Line | 825 OLD LANCASTER RD STE 400
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City | BRYN MAWR
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State | PA
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Zip | 19010-3236
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Country | US
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Telephone | 610-525-1202
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Fax | 610-527-0643
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Provider Business Mailing Address
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Address Line | 825 OLD LANCASTER RD STE 320
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City | BRYN MAWR
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State | PA
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Zip | 19010-3235
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Country | US
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Telephone | 610-527-3800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 6616
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD473091
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD-42601
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | MD473091
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 42601
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License Number State | IA
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