Provider Demographics
NPI:1780727255
Name:MANNAVA, SRIKRISHNA (MD)
Entity type:Individual
Prefix:DR
First Name:SRIKRISHNA
Middle Name:
Last Name:MANNAVA
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 1:6488 E MAIN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-7310
Mailing Address - Country:US
Mailing Address - Phone:614-729-8483
Mailing Address - Fax:614-472-8483
Practice Address - Street 1:6488 E MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-7310
Practice Address - Country:US
Practice Address - Phone:614-729-8483
Practice Address - Fax:614-472-8483
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0940762085R0204X
OH35094076208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2978185Medicaid
OH2978185Medicaid