| Manohar Vajja, Md Pa | |
|
6447 Malaga Irving TX 75039-3191 | |
| (972) 910-9341 | |
| (972) 499-2500 |
| Full Name | Manohar Vajja, Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 6447 Malaga, Irving, Texas |
| Authorized Official Name and Position | Manohar Prasad Vajja (PRESIDENT) |
| Authorized Official Contact | 9729109341 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Manohar Vajja, Md Pa 6447 Malaga Irving TX 75039-3191 Ph: (972) 910-9341 | Manohar Vajja, Md Pa 6447 Malaga Irving TX 75039-3191 Ph: (972) 910-9341 |
| NPI Number | 1790077279 |
|---|---|
| Provider Enumeration Date | 05/03/2011 |
| Last Update Date | 09/09/2011 |
| Medicare PECOS PAC ID | 6608045257 |
|---|---|
| Medicare Enrollment ID | O20110816000528 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790077279 | NPI | - | NPPES |
| TXB130027 | Other | TX | MEDICARE PART B |
| M7714 | Other | TX | LICENCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | M7714 (Texas) | Primary |
| Provider Name | Manohar P Vajja |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306048277 PECOS PAC ID: 9335219732 Enrollment ID: I20080528000106 |
| Provider Name | Srinivasa Reddy Kunam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043231046 PECOS PAC ID: 4981607157 Enrollment ID: I20151204000996 |
| Provider Name | Geoffrey Kinoti Maingi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437687548 PECOS PAC ID: 5294004487 Enrollment ID: I20170815001982 |
| Provider Name | Vivian T Powtakien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295123842 PECOS PAC ID: 3476874918 Enrollment ID: I20191212001783 |
| Provider Name | Melissa Nicole Stoup |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467003855 PECOS PAC ID: 5092149427 Enrollment ID: I20191218000903 |
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