Provider Demographics
NPI:1447464458
Name:MANJUNATH, SKANTHA KRUPA (MD)
Entity type:Individual
Prefix:DR
First Name:SKANTHA
Middle Name:KRUPA
Last Name:MANJUNATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 GARTH RD STE 111
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3157
Mailing Address - Country:US
Mailing Address - Phone:281-428-4510
Mailing Address - Fax:
Practice Address - Street 1:4201 GARTH RD STE 111
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3154
Practice Address - Country:US
Practice Address - Phone:281-428-4510
Practice Address - Fax:281-420-0222
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS2635207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program