Provider Demographics
NPI:1346219144
Name:MAJMUNDAR, SONAL D (DO)
Entity type:Individual
Prefix:
First Name:SONAL
Middle Name:D
Last Name:MAJMUNDAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVENUE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-963-0860
Mailing Address - Fax:
Practice Address - Street 1:2403 LOY DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-2701
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-8335
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002221A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11485478OtherCAQH NUMBER
IN000000184378OtherANTHEM PROVIDER NUMBER
IN9274781OtherPHCS PID NUMBER
IN200298090Medicaid
IN185510RRMedicare PIN
IN142080VVMedicare PIN
IN870630QMedicare PIN
IN300114619Medicare PIN
IN11485478OtherCAQH NUMBER
IN815460JJJMedicare PIN
IN224390NMedicare PIN
IN200298090Medicaid
IN000000184378OtherANTHEM PROVIDER NUMBER
INH24723Medicare UPIN