Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080N0001X | Neonatal-Perinatal Doctor | 30006 | WV |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 35-058587 | OH |
N | 2080N0001X | Neonatal-Perinatal Doctor | ME124923 | FL |
NPI | 1124080049 |
---|---|
Provider Name | Dr. Prem Lata Mehandru |
First Address | Jacksonville, NC 28546-6328 |
Second Address | Cincinnati, OH 45229-3026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 14/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000027600 | ANTHEM (01) | OH |
0894028 | (05) | OH |
3980958 | UNITED HEALTHCARE (01) | OH |
71422 | QUALCHOICE (01) | OH |
F82937 | (02) | OH |