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General NPI Number Information
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NPI Number | 1245266857
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Entity Type | Individual
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Provider Name | MAMATA GOPAL MAJMUNDAR M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 01/20/2018
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Provider Practice Location Address
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Address Line | 1306 VERSAILLES RD STE 120
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City | LEXINGTON
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State | KY
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Zip | 40504-1795
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Country | US
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Telephone | 859-259-2635
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Fax | 859-254-7874
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Provider Business Mailing Address
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Address Line | 3099 HELMSDALE PL
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City | LEXINGTON
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State | KY
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Zip | 40509-2213
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Country | US
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Telephone | 859-258-6401
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Fax | 859-255-1480
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 37758
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License Number State | KY
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