Individual
DR. INDIRA MOODUMANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
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 40743-0689
(606) 864-7337
(606) 878-3257
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
36054
KY
208000000X
Pediatrics Physician
Primary
36054
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64039019
—
KY
Enumeration date
08/12/2006
Last updated
10/23/2019
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