Provider Demographics
NPI:1427404680
Name:MANDALAPU, TAPASYA (MD)
Entity Type:Individual
Prefix:
First Name:TAPASYA
Middle Name:
Last Name:MANDALAPU
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 1:2109 W DAVIS ST STE C
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2045
Mailing Address - Country:US
Mailing Address - Phone:936-446-2227
Mailing Address - Fax:936-788-2221
Practice Address - Street 1:2109 W DAVIS ST STE C
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2045
Practice Address - Country:US
Practice Address - Phone:936-446-2227
Practice Address - Fax:936-788-2221
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS2405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program