Provider Demographics
NPI:1821140765
Name:MANTLE, BELINDA A (MD)
Entity Type:Individual
Prefix:DR
First Name:BELINDA
Middle Name:A
Last Name:MANTLE
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 1:200 HENRY CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118
Mailing Address - Country:US
Mailing Address - Phone:504-896-9832
Mailing Address - Fax:504-896-9296
Practice Address - Street 1:200 HENRY CLAY AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118
Practice Address - Country:US
Practice Address - Phone:504-896-9832
Practice Address - Fax:504-896-9296
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT186520174400000X
VA01012412422207Y00000X
VA0101241422207YP0228X, 207YX0602X
NMMD2016-0851207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA01012412422OtherSTATE LICENSE
0014OtherCAREFIRST
NMMD2016-0851OtherMEDICAL LICENSE
004031O15Medicare PIN