Provider Demographics
NPI:1083895932
Name:TAKHAR, MANBIR (MD)
Entity Type:Individual
Prefix:
First Name:MANBIR
Middle Name:
Last Name:TAKHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19504 AMARANTH DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1210
Mailing Address - Country:US
Mailing Address - Phone:301-428-1070
Mailing Address - Fax:301-428-3192
Practice Address - Street 1:19504 AMARANTH DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1210
Practice Address - Country:US
Practice Address - Phone:301-428-1070
Practice Address - Fax:301-428-3192
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046747207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG21068Medicare UPIN