Provider Demographics
NPI:1427053479
Name:MANUEL, CHEMPARATHY V (MD)
Entity type:Individual
Prefix:DR
First Name:CHEMPARATHY
Middle Name:V
Last Name:MANUEL
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 685
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-0685
Mailing Address - Country:US
Mailing Address - Phone:318-335-4200
Mailing Address - Fax:318-335-1267
Practice Address - Street 1:913 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-2201
Practice Address - Country:US
Practice Address - Phone:318-335-4200
Practice Address - Fax:318-335-1267
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07396R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1368148Medicaid
LA53211Medicare PIN
LA1368148Medicaid