Individual
DR. SULABHA S. MUJUMDAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3601 CUMBERLAND AVE, MIDDLESBORO, KY 40965-2613
(606) 248-3100
(606) 248-4141
Mailing address
3601 WEST CUMBERLAND AVENUE, P.O. BOX 1208, MIDDLESBORO, KY 40965
(606) 248-3100
(606) 248-4141
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
19968
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000047394
BLUE CROSS
KY
01
—
0033734
BLUE CARE/TN CARE SELECT
TN
05
—
006234241
—
VA
01
—
1307695
UMWA
KY
01
—
2196
CHA
KY
01
—
3195877
TN MEDICAID
TN
05
—
64199680
—
KY
01
—
K04395
CHAMPUS
KY
Enumeration date
10/17/2006
Last updated
08/02/2007
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