Provider Demographics
NPI:1528138419
Name:JAIN, MAMTA (MD)
Entity type:Individual
Prefix:DR
First Name:MAMTA
Middle Name:
Last Name:JAIN
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 132765
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77393-2765
Mailing Address - Country:US
Mailing Address - Phone:281-836-3627
Mailing Address - Fax:877-635-7901
Practice Address - Street 1:3115 COLLEGE PARK DR STE 112
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384
Practice Address - Country:US
Practice Address - Phone:281-836-3627
Practice Address - Fax:877-635-7901
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241513207R00000X
TXN0129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine