Manasa G Mantravadi, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

01075610A Issued in IN

Practice address

654 N Senate Ave
Indianapolis, IN 46202-3110

Phone

(812) 240-9789

NPI assigned

Mar 30, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1238371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489968000000",
    "number": "1508008020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "654 N SENATE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462023110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "654 N SENATE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462023110",
            "telephone_number": "812-240-9789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTRAVADI",
        "first_name": "MANASA",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-30",
        "last_updated": "2017-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME113007",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01075610A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201316090",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR PTAN",
            "identifier": "P01512486",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samsad Mansoor, MD
• Janet Marie Manthey, M.A.
• Mantis
• Avinash V Mantravadi, MD
• Geeta Karnik Mantravadi, M.D., M.S.
• Abigail Mantyla
• Gabriel Manuilow, PTA
• Schani Manungo, NP-C
• Robert Manuzzi
• Many Blessings Home Agency LLC

• Pediatrics Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Pediatrics Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2017; 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.