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General NPI Number Information
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NPI Number | 1992771075
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Entity Type | Individual
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Provider Name | RAMESH R MUNDRA MD
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Gender | Male
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 106 EAST MAIN ST
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City | WESTBOROUGH
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State | MA
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Zip | 01581
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Country | US
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Telephone | 508-898-2338
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Fax | 508-366-9938
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Provider Business Mailing Address
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Address Line | 630 PLANTATION ST WOT 12TH FLOOR, ATTN: PHYSICIAN SERVICES
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City | WORCESTER
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State | MA
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Zip | 01605
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Country | US
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Telephone | 508-368-5529
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Fax | 508-368-5530
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 38048
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License Number State | MA
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