Manjunath, Prema
Manjunath, Prema is an individual health care provider with primary practice located at 855 Montgomery St , Fort Worth TX 76107-2553. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Forensic Psychiatry, Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry. Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry is her primary health care specialty. Manjunath, Prema can be contacted via phone (817) 927-3638.Contact Information
Primary practice address
855 Montgomery St
Fort Worth TX 76107-2553
Phone: (817) 927-3638
Fax: (817) 923-8769
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Forensic Psychiatry | 2084F0202X | H3699 | Texas |
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | H3699 | Texas |
| Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry | 2084P0804X | H3699 | Texas |
Profile Details
| NPI number | 1013962745 |
|---|---|
| LBN Legal business name | Manjunath, Prema |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 23rd, 2006 |
| Last updated | Aug 9th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1013962745 | NPPES |
| Texas | Other | 83702S | BCBS |
| Texas | MEDICAID | 135013410 | BCBS |
| Texas | Other | P00340949 | BCBS |
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