Provider Demographics
NPI:1093887549
Name:MAJMUNDAR, MINA G (MD)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:G
Last Name:MAJMUNDAR
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 1:11217 MAIN ST
Mailing Address - Street 2:PO BOX 828
Mailing Address - City:MARTIN
Mailing Address - State:KY
Mailing Address - Zip Code:41649-0828
Mailing Address - Country:US
Mailing Address - Phone:606-285-9000
Mailing Address - Fax:606-285-9484
Practice Address - Street 1:ANESTHESIOLOGIST HRMC
Practice Address - Street 2:5000 321 N HRMC
Practice Address - City:POESTONSOUG
Practice Address - State:KY
Practice Address - Zip Code:41653
Practice Address - Country:US
Practice Address - Phone:606-285-3412
Practice Address - Fax:606-285-9484
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY19453207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000068353OtherBIC
KY1257782OtherUMWA
KY64194533Medicaid
KY1257782OtherUMWA
C74223Medicare UPIN