Provider Demographics
NPI:1194927905
Name:MANNAM, ARJUNA PRASAD (MD)
Entity type:Individual
Prefix:DR
First Name:ARJUNA
Middle Name:PRASAD
Last Name:MANNAM
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 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE # 2102
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-714-7905
Mailing Address - Fax:
Practice Address - Street 1:1000 ASYLUM AVE STE 4320
Practice Address - Street 2:SAINT FRANCIS MEDICAL GROUP,INC.
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1704
Practice Address - Country:US
Practice Address - Phone:860-714-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0452142084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology