Provider Demographics
NPI:1144232166
Name:MALLIKAMAS, MANANYA (MD)
Entity type:Individual
Prefix:
First Name:MANANYA
Middle Name:
Last Name:MALLIKAMAS
Suffix:
Gender:F
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 6687
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-0687
Mailing Address - Country:US
Mailing Address - Phone:410-263-6638
Mailing Address - Fax:410-268-6830
Practice Address - Street 1:14999 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1074
Practice Address - Country:US
Practice Address - Phone:443-332-4088
Practice Address - Fax:410-793-0809
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD23393207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC491046Medicare PIN