Healthcare Provider Details

I. General information

NPI: 1336127885
Provider Name (Legal Business Name): CHINMAY SARVOTTAM MAJMUNDAR M.D. F.A.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W 4TH ST STE 102
COOKEVILLE TN
38501-2476
US

IV. Provider business mailing address

127 N OAK AVE STE D
COOKEVILLE TN
38501-2435
US

V. Phone/Fax

Practice location:
  • Phone: 931-783-5515
  • Fax:
Mailing address:
  • Phone: 931-783-5582
  • Fax: 321-242-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number396869
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number61388
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: