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NPI Code Detail

MEDICARE: MANOHER BEARELLY M.D.

MEDICARE: MANOHER BEARELLY M.D.
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
12084P0804XChild & Adolescent Psychiatry Physician036058614IL
22084P0804XChild & Adolescent Psychiatry Physician2011033071MO

General Provider Information

NPI Number : 1407925241
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANOHER BEARELLY M.D.
Provider Business Mailing Address
First Line : 900 E LAHARPE ST
Second Line :
City : KIRKSVILLE
State : MO
Zip : 63501-4520
Country : US
Telephone Number : 660-665-1962
Fax Number : 660-665-3989
Provider Business Practice Location Address
First Line : 141 COMMUNICATION DR
Second Line :
City : HANNIBAL
State : MO
Zip : 63401-3670
Country : US
Telephone Number : 573-603-1460
Fax Number : 573-603-1462
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 02/29/2016

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