Rao VP Mantravadi, MD

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

01032697A Issued in IN

Practice address

7910 W Jefferson Blvd Ste 110
Fort Wayne, IN 46804-4159

Phone

(260) 436-4116

Fax

(260) 436-1878

NPI assigned

Aug 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466380800000",
    "number": "1194726927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7910 W JEFFERSON BLVD STE 110",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044159",
            "telephone_number": "260-436-4116",
            "fax_number": "260-436-1878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7910 W JEFFERSON BLVD STE 110",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044159",
            "telephone_number": "260-436-4116",
            "fax_number": "260-436-1878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTRAVADI",
        "first_name": "RAO",
        "middle_name": "VP",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2016-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "IN",
            "license": "01032697A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100321360",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194726927",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0573026",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Magdalena Ruth Mannes, NP
• Julie Anne Manry, O.D.
• David James Mansfield, CRNA
• Dennis Dale Mansfield, M.D.
• Rama Mansour
• Maricela Manuel
• Mary V Manz, PTA
• Maple Seed Farms, Inc.
• Maple Seed Farms, Inc.
• Russell Vaughn Maples, M.D.

• Radiation Oncology Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Radiation Oncology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.