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Individual
MANTHODI KULANGARA FAISAL
Active
Individual
MANTHODI KULANGARA FAISAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
C1-0009736
DE
207RN0300X
Nephrology Physician
D0072245
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019782510001
—
PA
05
—
1019782510002
—
PA
01
—
2088888
HIGHMARK BLUE SHIELD
PA
01
—
2859911000
BCBS
PA
Enumeration date
12/29/2006
Last updated
06/22/2021
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