MEDICARE: MAMATHA PASNOOR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	0431646	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37125014	OTHER	MO	BCBS OF KANSAS CITY

General Provider Information

NPI Number	:	1437352820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAMATHA PASNOOR MD

Provider Business Mailing Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	4070 DELP MAIL STOP 4017
City	:	KANSAS CITY
State	:	KS
Zip	:	66160
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	LANDON CENTER ON AGING
Second Line	:	3599 RAINBOW BLVD MAIL STOP 2012
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-7314
Country	:	US
Telephone Number	:	913-588-6970
Fax Number	:	913-588-6965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/09/2007

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