Provider Demographics
NPI:1073572525
Name:MAMMEN, ANJU ANNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANJU
Middle Name:ANNIE
Last Name:MAMMEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ANJU
Other - Middle Name:ANNIE
Other - Last Name:KOSHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:777 S FRY RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2244
Mailing Address - Country:US
Mailing Address - Phone:281-492-7676
Mailing Address - Fax:281-492-8133
Practice Address - Street 1:777 S FRY RD
Practice Address - Street 2:SUITE 207
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2244
Practice Address - Country:US
Practice Address - Phone:281-492-7676
Practice Address - Fax:281-492-8133
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7397208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010042497CT01OtherBCS
TX282923603Medicaid
CT004236164Medicaid
CT042497OtherCTC