NPIMap

Individual provider Active NPI

Manju A. Mavanur, MD

  • Nephrology Physician
  • Baltimore, MD
National Provider Identifier
1164434932
Registry record updated Oct 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
D71314 Issued in MD
Practice address
22 S Greene St
Baltimore, MD 21201-1544
Phone
(410) 706-4613
Fax
(410) 706-4619
NPI assigned
Aug 12, 2006
Last updated
Oct 3, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X D71314 MD Primary
Hospitalist Physician 208M00000X 044583 CT

Addresses

Primary practice location

22 S Greene St
Baltimore, MD 21201-1544

Mailing address

PO Box 64442
Baltimore, MD 21264-4442
Phone (410) 706-4613

Other identifiers 2

IdentifierTypeStateIssuer
S062-0484OtherMDCAREFIRST BC/BS
036099600MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120820000707 MD Practitioner - Nephrology 8426054461 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid-Atlantic Nephrology Associates PAGroup PAC ID 2769469006, 60 clinicians

Practice addresses (Care Compare)

25 Crossroads Dr
Suite 205
Owings Mills, MD 21117-5533
Phone (410) 602-7792

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
044583CTMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Maryland Physicians PA Nephrology CurrentSince Aug 1, 2012 Accepting new patients
University of Maryland Physicians PA Nephrology Current Accepting new patients
Mid-Atlantic Nephrology Associates PA Nephrology CurrentSince Feb 1, 2019 Accepting new patients
University of Maryland Physicians P.a. CurrentSince Aug 1, 2012 Accepting new patients
University of Maryland Physicians P.a. Current Accepting new patients
University of Maryland Physicians P.a. Current Accepting new patients
The Hospital of Central Connecticut at New Britain General and Bradley Past Accepting new patients

Locations

22 S Greene St
Baltimore, MD 21201
Phone (410) 328-5793

1589 Sulphur Spring Rd
Ste 109
Halethorpe, MD 21227
Phone (410) 536-5400

25 Crossroads Dr
Ste 205
Owings Mills, MD 21117
Phone (410) 602-7792

Interoperability endpoints

  • Direct secure messaging: manjumavanur@mana.allscriptsdirect.net

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349222400000",
    "number": "1164434932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64442",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212644442",
            "telephone_number": "410-706-4613",
            "fax_number": "410-706-4619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011544",
            "telephone_number": "410-706-4613",
            "fax_number": "410-706-4619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAVANUR",
        "first_name": "MANJU",
        "middle_name": "A.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-12",
        "last_updated": "2012-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MD",
            "license": "D71314",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CT",
            "license": "044583",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BC/BS",
            "identifier": "S062-0484",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036099600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.