Provider Demographics
NPI:1497737126
Name:AYYAR, S. MANNY (MD)
Entity type:Individual
Prefix:
First Name:S.
Middle Name:MANNY
Last Name:AYYAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SUBRAMANYAM
Other - Middle Name:MANNY
Other - Last Name:AYYAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:24518 NORTHWEST FWY
Mailing Address - Street 2:MOB 2 SUITE245
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429
Mailing Address - Country:US
Mailing Address - Phone:346-618-4400
Mailing Address - Fax:346-618-4401
Practice Address - Street 1:24518 NORTHWEST FWY
Practice Address - Street 2:MOB 2 SUITE245
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429
Practice Address - Country:US
Practice Address - Phone:346-618-4400
Practice Address - Fax:346-618-4401
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7425208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0376907-01Medicaid
TX8H2061OtherBLUE CROSS BLUE SHIELD
TX8H2061OtherBLUE CROSS BLUE SHIELD
TX8085J1Medicare PIN