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General NPI Number Information
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NPI Number | 1588813257
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Entity Type | Individual
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Provider Name | MANOJ MRINAL MAZUMDER MD
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Gender | Male
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Dates
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Enumeration Date | 09/17/2008
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Last Update Date | 12/30/2011
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Provider Practice Location Address
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Address Line | 877 JEFFERSON AVE
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City | MEMPHIS
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State | TN
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Zip | 38103-2807
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Country | US
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Telephone | 901-545-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 4380 HARDGREAVES LN APT # 308
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City | MEMPHIS
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State | TN
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Zip | 38125-2496
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Country | US
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Telephone | 501-749-1520
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 47627
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | E6321
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License Number State | AR
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