Individual
DR. MONUJ TRIVEN BASHAMBU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-0650
Mailing address
1499 WALTON WAY, SUITE 1400, AUGUSTA, GA 30901-2602
(706) 828-6410
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
LL29238
SC
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
068983
GA
2080N0001X
Neonatal-Perinatal Medicine Physician
35.094111
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000785511
ANTHEM
OH
05
—
0072631
—
OH
01
—
35.094111
LICENSE
OH
01
—
9105965
AETNA
OH
Enumeration date
10/13/2006
Last updated
08/16/2013
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