Provider Demographics
NPI:1336127885
Name:MAJMUNDAR, CHINMAY SARVOTTAM (MD FACS)
Entity Type:Individual
Prefix:
First Name:CHINMAY
Middle Name:SARVOTTAM
Last Name:MAJMUNDAR
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N OAK AVE STE D
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2435
Mailing Address - Country:US
Mailing Address - Phone:931-783-5582
Mailing Address - Fax:321-242-6050
Practice Address - Street 1:145 W 4TH ST STE 102
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2476
Practice Address - Country:US
Practice Address - Phone:931-783-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL396869208600000X
TN61388208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276713900Medicaid
FLP00415987OtherRR MEDICARE
FL276713900Medicaid
FLAC550ZMedicare PIN