Healthcare Provider Details

I. General information

NPI: 1366454407
Provider Name (Legal Business Name): MANEESH BATRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST C212, BOX 356340
SEATTLE WA
98195-6340
US

IV. Provider business mailing address

1959 NE PACIFIC ST C212, BOX 356340
SEATTLE WA
98195-6340
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-0065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD00042491
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: