Healthcare Provider Details

I. General information

NPI: 1689612392
Provider Name (Legal Business Name): BHARTI M MANCHANDIA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 BERT KOUNS INDUSTRIAL LOOP
SHREVEPORT LA
71118-3119
US

IV. Provider business mailing address

5679 MIRADOR CIR
SHREVEPORT LA
71119-4009
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-5395
  • Fax:
Mailing address:
  • Phone: 318-222-2229
  • Fax: 318-746-9669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number05496R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: