Provider Demographics
NPI:1346251865
Name:MANUEL, POWLIN VISWAS (MD)
Entity Type:Individual
Prefix:
First Name:POWLIN
Middle Name:VISWAS
Last Name:MANUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 GENEVIEVE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-4811
Mailing Address - Country:US
Mailing Address - Phone:337-984-0110
Mailing Address - Fax:
Practice Address - Street 1:104 GENEVIEVE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-4811
Practice Address - Country:US
Practice Address - Phone:337-984-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03959R208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1171689Medicaid
LA1171689Medicaid
5L062Medicare ID - Type Unspecified