Provider Demographics
NPI:1295744670
Name:WADHWA, MANJIT K (MD)
Entity type:Individual
Prefix:
First Name:MANJIT
Middle Name:K
Last Name:WADHWA
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:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70069-1450
Mailing Address - Country:US
Mailing Address - Phone:985-651-9293
Mailing Address - Fax:
Practice Address - Street 1:383 OAK TREE DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-1911
Practice Address - Country:US
Practice Address - Phone:985-651-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05651R207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1321133Medicaid
TX195199801Medicaid
LA1321133Medicaid
TX195199801Medicaid
TX195199801Medicaid