Provider Demographics
NPI:1134108749
Name:PABLA, MANISH SINGH (DPM)
Entity Type:Individual
Prefix:DR
First Name:MANISH
Middle Name:SINGH
Last Name:PABLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 SEATON SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4500
Mailing Address - Country:US
Mailing Address - Phone:301-593-9250
Mailing Address - Fax:866-892-0685
Practice Address - Street 1:628 SEATON SQUARE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901
Practice Address - Country:US
Practice Address - Phone:301-593-9250
Practice Address - Fax:866-892-0685
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01254213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC5239OtherCAREFIRST BCBS
MD400123100Medicaid
MDT441MSOtherCAREFIRST BCBS
DC5239OtherCAREFIRST BCBS
MDT441MSOtherCAREFIRST BCBS