Provider Demographics
NPI:1881639581
Name:MANDALAPU, B PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:B PRASAD
Middle Name:
Last Name:MANDALAPU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8700 MANCHACA RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5371
Mailing Address - Country:US
Mailing Address - Phone:512-617-1841
Mailing Address - Fax:512-280-6750
Practice Address - Street 1:8700 MANCHACA RD
Practice Address - Street 2:SUITE 205
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5371
Practice Address - Country:US
Practice Address - Phone:512-617-1841
Practice Address - Fax:512-280-6750
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK96062084N0400X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U5180OtherBCBS
TX8U5180OtherBCBS
TX8F3536Medicare PIN