Provider Demographics
NPI:1225288293
Name:BANGA, MADHUMITA (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHUMITA
Middle Name:
Last Name:BANGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADHUMITA
Other - Middle Name:
Other - Last Name:CHATTOPADHYAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 66308
Mailing Address - Street 2:ATTN: BILLING/CREDENTIALING
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-6308
Mailing Address - Country:US
Mailing Address - Phone:832-548-5275
Mailing Address - Fax:713-559-3255
Practice Address - Street 1:4301 GARTH RD STE 400
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3159
Practice Address - Country:US
Practice Address - Phone:832-548-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128201207Q00000X
TXP5028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.128201Medicaid
TX741843OtherLEGACY COMMUNITY HEALTH SERVICES, INC. SITE MEDICARE #