Individual
MAMATA GOPAL MAJMUNDAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1306 VERSAILLES RD STE 120, LEXINGTON, KY 40504-1795
(859) 259-2635
(859) 254-7874
Mailing address
3099 HELMSDALE PL, LEXINGTON, KY 40509-2213
(859) 258-6401
(859) 255-1480
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37758
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICAID LAB GROUP#
KY
01
—
4000501
MEDICARE LAB GROUP#
KY
05
—
64066699
—
KY
01
—
CB5773
RR MEDICARE GROUP#
GA
01
—
P00034949
RR MEDICARE PIN#
GA
Enumeration date
06/24/2006
Last updated
01/20/2018
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