Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD60136124 | WA |
N | 111NI0900X | Internist | MD60136124 | WA |
N | 207RC0200X | Critical Care Medicine | MD60136124 | WA |
N | 207RP1001X | Pulmonary Disease | MD25897 | OR |
Y | 207RP1001X | Pulmonary Disease | MD60136124 | WA |
NPI | 1083769194 |
---|---|
Provider Name | Babith Mankidy |
First Address | Tacoma, WA 98405-2922 |
Second Address | Tacoma, WA 98405-2922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 01/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
278884 | (05) | OR |