Provider Demographics
NPI:1679567317
Name:DULEMBA AND MANTRI MD PA
Entity Type:Organization
Organization Name:DULEMBA AND MANTRI MD PA
Other - Org Name:THE WOMENS CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUHAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANTRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-387-6248
Mailing Address - Street 1:3321 UNICORN LAKE BLVD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0106
Mailing Address - Country:US
Mailing Address - Phone:940-387-6248
Mailing Address - Fax:940-381-1881
Practice Address - Street 1:3321 UNICORN LAKE BLVD
Practice Address - Street 2:SUITE 121
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0106
Practice Address - Country:US
Practice Address - Phone:940-387-6248
Practice Address - Fax:940-381-1881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085636101Medicaid
TX00U36QMedicare PIN