Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301069879 | MI |
N | 111NI0900X | Internist | 4301069879 | MI |
Y | 207RA0401X | Internist - Addiction Medicine | 01011252176 | VA |
NPI | 1952302044 |
---|---|
Provider Name | Radhika A. Manhapra |
First Address | Virginia Beach, VA 23455 |
Second Address | Hampton, VA 23667-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 26/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300207909 | TAX ID (01) | MI |
4692200 | (05) | MI |
H33307 | (02) | MI |
P00206767 | PALMETTO MEDICARE (01) |