Provider Demographics
NPI:1437290004
Name:MAJMUNDAR, KSHITIJ VIPIN (MD)
Entity Type:Individual
Prefix:
First Name:KSHITIJ
Middle Name:VIPIN
Last Name:MAJMUNDAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 933087
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-3087
Mailing Address - Country:US
Mailing Address - Phone:770-475-3361
Mailing Address - Fax:770-664-4431
Practice Address - Street 1:1360 UPPER HEMBREE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1146
Practice Address - Country:US
Practice Address - Phone:770-475-3361
Practice Address - Fax:770-664-4431
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA57545174400000X, 207YX0905X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA57545OtherMEDICAL LICENSE