Individual
MAMATA MYNENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 ERWIN RD, BANNER GOOD SAMARITAN MEDICAL CENTER, DURHAM, NC 27705-3941
(919) 684-8111
Mailing address
5213 S ALSTON AVE, DURHAM, NC 27713-4430
(919) 620-8111
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A130515
CA
2085R0202X
Diagnostic Radiology Physician
ME125336
FL
Other
Enumeration date
06/22/2007
Last updated
09/11/2015
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