1962483602 NPI number — DR. MANJARI MOTAPARTHI M.D.

Table of content: DR. MANJARI MOTAPARTHI M.D. (NPI 1962483602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962483602 NPI number — DR. MANJARI MOTAPARTHI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOTAPARTHI
Provider First Name:
MANJARI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962483602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 950202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40295-0202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-588-9490
Provider Business Mailing Address Fax Number:
502-272-5116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3991 DUTCHMANS LN STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-889-6782
Provider Business Practice Location Address Fax Number:
502-899-6783
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  01061427 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 40998 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000553249 . This is a "ANTHEM - NNS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 196290DDDD . This is a "MEDICARE - NNS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 64119290 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 088968 . This is a "SIHO - NNS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1606069 . This is a "CIGNA - NNS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000023032V . This is a "HUMANA - NNS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 094759 . This is a "SIHO - CMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200838970 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50020053 . This is a "PASSPORT - NNS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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