Provider Demographics
NPI:1972628436
Name:MANIKUMAR, RADHIKA JAYARAJ (MD)
Entity type:Individual
Prefix:DR
First Name:RADHIKA
Middle Name:JAYARAJ
Last Name:MANIKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RADHIKA
Other - Middle Name:
Other - Last Name:JAYARAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:23218 BREWERS TAVERN WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871
Mailing Address - Country:US
Mailing Address - Phone:301-528-8181
Mailing Address - Fax:
Practice Address - Street 1:23218 BREWERS TAVERN WAY
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-4391
Practice Address - Country:US
Practice Address - Phone:301-528-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061929208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics