Provider Demographics
NPI:1659452985
Name:MANTRI, SUHAS D (MD)
Entity Type:Individual
Prefix:
First Name:SUHAS
Middle Name:D
Last Name:MANTRI
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 1:3321 UNICORN LAKE BLVD STE 121
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0107
Mailing Address - Country:US
Mailing Address - Phone:940-387-6248
Mailing Address - Fax:940-381-1881
Practice Address - Street 1:3321 UNICORN LAKE BLVD STE 121
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0107
Practice Address - Country:US
Practice Address - Phone:940-387-6248
Practice Address - Fax:940-381-1881
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5288207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042778303Medicaid
TX042778304Medicaid
TX042778302Medicaid
TXTXB112880Medicare PIN
TXTXB112883Medicare PIN
TX042778302Medicaid