Provider Demographics
NPI:1336169945
Name:MANOHAR, PRITI M (MD)
Entity type:Individual
Prefix:DR
First Name:PRITI
Middle Name:M
Last Name:MANOHAR
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 4784
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4784
Mailing Address - Country:US
Mailing Address - Phone:956-683-9300
Mailing Address - Fax:956-683-9323
Practice Address - Street 1:3125 CENTER POINTE DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-683-9300
Practice Address - Fax:956-683-9323
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM04792084N0402X, 2084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173741301Medicaid
TXI25488Medicare UPIN
TX173741301Medicaid