Basic Information
| Provider Information | |||||||||
| NPI: | 1518078831 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANNE | ||||||||
| FirstName: | RAJA | ||||||||
| MiddleName: | SEKHAR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 CHESTNUT HILL RD | ||||||||
| Address2: | |||||||||
| City: | STAFFORD SPRINGS | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060764005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606844251 | ||||||||
| FaxNumber: | 8606848165 | ||||||||
| Practice Location | |||||||||
| Address1: | 71 HAYNES ST STE 1209 | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060404131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605336595 | ||||||||
| FaxNumber: | 8605336594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 01/22/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 045540 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 045540 | CT | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 001455402 | 05 | CT | MEDICAID | 110010327 | 01 | CT | MEDICARE PTAN | OTHER |