Provider Demographics
NPI:1043246499
Name:RANDHAWA, MANJIT (DO)
Entity Type:Individual
Prefix:
First Name:MANJIT
Middle Name:
Last Name:RANDHAWA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 E MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-3948
Mailing Address - Country:US
Mailing Address - Phone:979-848-3068
Mailing Address - Fax:979-849-1423
Practice Address - Street 1:1980 EAST MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515
Practice Address - Country:US
Practice Address - Phone:979-848-3068
Practice Address - Fax:979-849-1423
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4464207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137351614Medicaid
TX137351612Medicaid
TXP00954847OtherMEDICARE RAILROAD FACO
TX050062192OtherUNSPECIFIED RAILROAD MEDICARE
TX137351613Medicaid
P00200151OtherRAILROAD MEDICARE
TXTXB114089Medicare PIN
TX137351612Medicaid