Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 0101252175 | VA |
NPI | 1699878140 |
---|---|
Provider Name | Ajay Manhapra |
First Address | Hampton, VA 23667-0001 |
Second Address | Hampton, VA 23667-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 11/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4280341 | (05) | MI |
H02736 | (02) | MI |