MEDICARE: SHUBHANG MAZUMDAR 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	207R00000X	Internal Medicine Physician	19297	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GRP2975	OTHER	GA	MEDICARE GROUP NUMBER
3	DD5386	OTHER	GA	RAILROAD MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477608016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHUBHANG MAZUMDAR MD

Provider Business Mailing Address
First Line	:	2550 WINDY HILL RD SE STE 309
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8655
Country	:	US
Telephone Number	:	770-951-1565
Fax Number	:	770-988-0563

Provider Business Practice Location Address
First Line	:	2550 WINDY HILL RD SE STE 309
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8655
Country	:	US
Telephone Number	:	770-951-1565
Fax Number	:	770-988-0563

Authorized Official
Title or Position	:	BILLING PERSON
Name	:	MS. HELEN CHANG
Credential	:
Telephone Number	:	770-952-2048

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	10/27/2010

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Directions to “SHUBHANG MAZUMDAR MD ” Practice Location

Language	Start Address	Practice Location

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