Provider Demographics
NPI:1306048277
Name:VAJJA, MANOHAR P (MD)
Entity type:Individual
Prefix:DR
First Name:MANOHAR
Middle Name:P
Last Name:VAJJA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6565 N MACARTHUR BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2482
Mailing Address - Country:US
Mailing Address - Phone:877-362-7291
Mailing Address - Fax:877-362-7291
Practice Address - Street 1:3500 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3460
Practice Address - Country:US
Practice Address - Phone:214-886-8496
Practice Address - Fax:877-362-7291
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2020-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10016737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K5738Medicare PIN