MEDICARE: MANOHAR R. MANCHANDIA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	05497R	LA

General Provider Information

NPI Number	:	1023086873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANOHAR R. MANCHANDIA MD

Provider Business Mailing Address
First Line	:	2706 SHED RD
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3348
Country	:	US
Telephone Number	:	318-747-5272
Fax Number	:	318-746-9669

Provider Business Practice Location Address
First Line	:	2706 SHED RD
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3348
Country	:	US
Telephone Number	:	318-747-5272
Fax Number	:	318-746-9669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	10/31/2024

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