Provider Demographics
NPI:1992771075
Name:MUNDRA, RAMESH R (MD)
Entity type:Individual
Prefix:
First Name:RAMESH
Middle Name:R
Last Name:MUNDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:WOT 12TH FLOOR, ATTN: PHYSICIAN SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-5529
Mailing Address - Fax:508-368-5530
Practice Address - Street 1:106 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-898-2338
Practice Address - Fax:508-366-9938
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA38048208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA1254OtherHARVARD PILGRIM
E18009OtherBLUE SHIELD INDEMNITY
E18009OtherMEDICARE B
MA2033658Medicaid
5296161OtherAETNA US HEALTHCARE
918070OtherFIRST HEALTH
E18009OtherBLUE CARE ELECT
5327618OtherCIGNA HEALTH PLAN
784164OtherMVP HEALTH CARE
9900229OtherFALLON COMMUNITY HEALTH
26841OtherCHILDRENS MED SECURITY
2033658OtherMEDICAID WELFARE
E18009OtherBLUE SHIELD HMO BLUE
F19970Medicare UPIN
MA2033658Medicaid