Individual
DR. PREM LATA MEHANDRU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3333 BURNET AVE, CINCINNATI, OH 45229-3026
(513) 636-4830
(513) 636-7868
Mailing address
120 MEMORIAL DR, JACKSONVILLE, NC 28546-6328
(910) 353-0581
(910) 353-1536
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
30006
WV
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
35-058587
OH
2080N0001X
Neonatal-Perinatal Medicine Physician
ME124923
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000027600
ANTHEM
OH
05
—
0894028
—
OH
01
—
3980958
UNITED HEALTHCARE
OH
01
—
71422
QUALCHOICE
OH
Enumeration date
04/05/2006
Last updated
09/14/2021
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