Organization
PARKWAY PEDIATRICS PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
INDIRA MOODUMANE MD (PEDIATRIC PHYSICIAN)
(606) 864-7337
Entity
Organization
Contact information
Practice address
809 MEYERS BAKER RD, SUITE 1, LONDON, KY 40741-3025
(606) 864-7337
(606) 878-3257
Mailing address
PO BOX 689, LONDON, KY 40741
(606) 864-7337
(606) 878-3257
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
36054
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65942187
—
KY
Enumeration date
03/21/2006
Last updated
06/24/2009
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