Individual
MANTHODI KULANGARA FAISAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4923 OGLETOWN STANTON RD, SUITE 200, NEWARK, DE 19713-2081
(302) 225-0451
(302) 225-0472
Mailing address
4923 OGLETOWN STANTON RD, SUITE 200, NEWARK, DE 19713-2081
(302) 225-0451
(302) 225-0472
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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