Provider Demographics
NPI:1477608016
Name:SHUBHANG MAZUMDAR MD
Entity Type:Organization
Organization Name:SHUBHANG MAZUMDAR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING PERSON
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-952-2048
Mailing Address - Street 1:2550 WINDY HILL RD SE STE 309
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8655
Mailing Address - Country:US
Mailing Address - Phone:770-951-1565
Mailing Address - Fax:770-988-0563
Practice Address - Street 1:2550 WINDY HILL RD SE STE 309
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8655
Practice Address - Country:US
Practice Address - Phone:770-951-1565
Practice Address - Fax:770-988-0563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2975OtherMEDICARE GROUP NUMBER
GA00266791CMedicaid
GADD5386OtherRAILROAD MEDICARE GROUP NUMBER
GA107563911BMedicare ID - Type UnspecifiedPROVIDER NUMBER
GA00266791CMedicaid
GAGRP2975OtherMEDICARE GROUP NUMBER