Provider Demographics
NPI:1194229260
Name:BULATHSINGHALA, MARIE SIOUSSAT SHANER (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:SIOUSSAT SHANER
Last Name:BULATHSINGHALA
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 BRADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-9145
Mailing Address - Country:US
Mailing Address - Phone:610-304-0212
Mailing Address - Fax:
Practice Address - Street 1:1542 TULANE AVE STE 441
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2865
Practice Address - Country:US
Practice Address - Phone:504-568-3792
Practice Address - Fax:504-568-2127
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program