Provider Demographics
NPI:1306937669
Name:LINGAMURTHY, MANJESH (MD)
Entity type:Individual
Prefix:DR
First Name:MANJESH
Middle Name:
Last Name:LINGAMURTHY
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:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-923-1872
Mailing Address - Fax:941-923-3947
Practice Address - Street 1:3830 BEE RIDGE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1105
Practice Address - Country:US
Practice Address - Phone:941-923-1872
Practice Address - Fax:941-923-3947
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230284207RH0003X
FLME101303207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000095400Medicaid
FLH46146Medicare UPIN
FLAP647ZMedicare PIN