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NPI Code Detail

MEDICARE: POONAM MANASA, M.D. P.A.

MEDICARE: POONAM MANASA, M.D. P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician

General Provider Information

NPI Number : 1679821516
Entity Type Code : Organization
Provider Name (Legal Business Name) : POONAM MANASA, M.D. P.A.
Provider Business Mailing Address
First Line : 3238 OLD COACH DR
Second Line :
City : NEW BRAUNFELS
State : TX
Zip : 78130-2665
Country : US
Telephone Number : 727-560-0522
Fax Number :
Provider Business Practice Location Address
First Line : 2041 SUNDANCE PKWY
Second Line :
City : NEW BRAUNFELS
State : TX
Zip : 78130-2779
Country : US
Telephone Number : 727-560-0522
Fax Number :
Authorized Official
Title or Position : OWNER
Name : POONAM M. MANASA
Credential : M.D.
Telephone Number : 727-560-0522
Provider Enumeration Date : 08/27/2012
Last Update Date : 08/27/2012

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