Provider Demographics
NPI:1962483602
Name:MOTAPARTHI, MANJARI (MD)
Entity Type:Individual
Prefix:DR
First Name:MANJARI
Middle Name:
Last Name:MOTAPARTHI
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:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3991 DUTCHMANS LN STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4700
Practice Address - Country:US
Practice Address - Phone:502-889-6782
Practice Address - Fax:502-899-6783
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010614272084N0400X
KY409982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000553249OtherANTHEM - NNS
IN196290DDDDOtherMEDICARE - NNS
KY64119290Medicaid
KY088968OtherSIHO - NNS
KY1606069OtherCIGNA - NNS
KY000023032VOtherHUMANA - NNS
KY094759OtherSIHO - CMA
IN200838970Medicaid
KY50020053OtherPASSPORT - NNS
KY088968OtherSIHO - NNS
KY094759OtherSIHO - CMA