Provider Demographics
NPI:1881905925
Name:BHATTARAI, MANOJ (MD)
Entity type:Individual
Prefix:
First Name:MANOJ
Middle Name:
Last Name:BHATTARAI
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 1:11301 OKEECHOBEE BLVD
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8719
Mailing Address - Country:US
Mailing Address - Phone:561-283-0384
Mailing Address - Fax:561-282-3238
Practice Address - Street 1:11301 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE 5A
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8719
Practice Address - Country:US
Practice Address - Phone:561-283-0384
Practice Address - Fax:561-282-3238
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01913207R00000X
FLME124542207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017232000Medicaid