Provider Demographics
NPI:1104916170
Name:MANALO, BAYANI LIPANA (MD)
Entity type:Individual
Prefix:DR
First Name:BAYANI
Middle Name:LIPANA
Last Name:MANALO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 SEVEN CORNERS PLACE
Mailing Address - Street 2:SUITE G
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2032
Mailing Address - Country:US
Mailing Address - Phone:703-241-2400
Mailing Address - Fax:703-534-8506
Practice Address - Street 1:6400 SEVEN CORNERS PLACE
Practice Address - Street 2:SUITE G
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2032
Practice Address - Country:US
Practice Address - Phone:703-241-2400
Practice Address - Fax:703-534-8506
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA022323207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6045961Medicaid
C62136Medicare ID - Type Unspecified
O30325Medicare UPIN