Provider Demographics
NPI:1235997313
Name:MAFTUNA KAYUMOVA MD PA
Entity Type:Organization
Organization Name:MAFTUNA KAYUMOVA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAFTUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYUMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:929-363-7962
Mailing Address - Street 1:3620 N JOSEY LN STE 115
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-3151
Mailing Address - Country:US
Mailing Address - Phone:929-363-7962
Mailing Address - Fax:
Practice Address - Street 1:3620 N JOSEY LN STE 115
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-3151
Practice Address - Country:US
Practice Address - Phone:929-363-7962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty