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General NPI Number Information
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NPI Number | 1407902364
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Entity Type | Individual
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Provider Name | MRIDUL K MAZUMDER M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 1616 PHYSICIANS DR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4619
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Country | US
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Telephone | 850-431-5119
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Fax | 850-431-2467
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Provider Business Mailing Address
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Address Line | 1115 W CALL ST
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City | TALLAHASSEE
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State | FL
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Zip | 32304-3556
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Country | US
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Telephone | 850-431-5119
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Fax | 850-431-2467
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME129519
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 27255
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License Number State | SC
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