Provider Demographics
NPI:1275881989
Name:PAMMI, INDIRA BAI (MD)
Entity Type:Individual
Prefix:MRS
First Name:INDIRA
Middle Name:BAI
Last Name:PAMMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 KRISTI DRIVE
Mailing Address - Street 2:
Mailing Address - City:MUTTONTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1309
Mailing Address - Country:US
Mailing Address - Phone:516-935-7371
Mailing Address - Fax:516-935-7371
Practice Address - Street 1:6, KRISTI DRIVE
Practice Address - Street 2:
Practice Address - City:MUTTONTOWN
Practice Address - State:NY
Practice Address - Zip Code:11753-1309
Practice Address - Country:US
Practice Address - Phone:516-935-7371
Practice Address - Fax:516-935-7371
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117734-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice