Provider Demographics
NPI:1053609644
Name:LAKRA, MANJU (MD)
Entity type:Individual
Prefix:
First Name:MANJU
Middle Name:
Last Name:LAKRA
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 1:1011 TIGER BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2915
Mailing Address - Country:US
Mailing Address - Phone:864-722-0283
Mailing Address - Fax:864-722-0261
Practice Address - Street 1:1011 TIGER BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2915
Practice Address - Country:US
Practice Address - Phone:864-722-0283
Practice Address - Fax:864-722-0261
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-16
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33844207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine