Mamatha Mandava, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

206428 Issued in LA

Practice address

1501 Kings Hwy
Department of Pediatrics
Shreveport, LA 71103-4228

Phone

(318) 675-6076

Fax

(318) 675-6059

NPI assigned

May 4, 2010

Last updated

Aug 5, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Children's Hospital

  • Children's Hospital
  • Washington, DC
  • NPI 1912939703
  Medicare reassignment NPD
• Harris Memorial Pediatric Clinic, LLC

  • Primary Care Clinic/Center
  • Shreveport, LA
  • NPI 1285065383
  NPD
• Children's Hospital

  dba Children's National Specialty Pharmacy

  • Community/Retail Pharmacy
  • Silver Spring, MD
  • NPI 1326878349
  NPD
• Children's Hospital

  dba Children's National Medical Associates

  • Pediatrics Physician
  • Washington, DC
  • NPI 1780800128
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375660800000",
    "number": "1346568177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 W KIRBY PL",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033822",
            "telephone_number": "318-675-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "DEPARTMENT OF PEDIATRICS",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-675-6076",
            "fax_number": "318-675-6059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDAVA",
        "first_name": "MAMATHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-04",
        "last_updated": "2013-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "206428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2103351",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zainab Manan, MD
• Prakash V Manapragada, MD
• Kenneth James Manas, M.D.
• Bharti M Manchandia, M.D
• Mary Catherine Mancini, M.D.
• Latoyta Mandosia
• Kellie Mandygo
• Matthew Manfredo, MD
• Payton Mangham
• Elizabeth Mangum, NP

• Pediatrics Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.