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Individual

DR. PRANITHA MANTRALA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
267 GRANT ST, BRIDGEPORT, CT 06610-2805
(203) 641-5484
Mailing address
267 GRANT ST, BRIDGEPORT, CT 06610-2805

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
276789
NY
208M00000X
Hospitalist Physician
276789
NY
208M00000X
Hospitalist Physician
Primary
56312
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03914463
NY
Enumeration date
08/23/2011
Last updated
02/07/2024
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