Provider Demographics
NPI:1679707988
Name:KUMAR, MAMTA (MD)
Entity Type:Individual
Prefix:
First Name:MAMTA
Middle Name:
Last Name:KUMAR
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 1:4515 SETON CENTER PARKWAY
Mailing Address - Street 2:SUITE 215-CREDENTIALING
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5785
Mailing Address - Country:US
Mailing Address - Phone:512-231-5548
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1401 MEDICAL PARKWAY
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7464
Practice Address - Country:US
Practice Address - Phone:512-324-4083
Practice Address - Fax:512-406-7398
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2710207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX541353YLP1OtherMEDICARE PTAN
TX541353YKXVOtherMEDICARE PTAN
TX541353YKXYOtherMEDICARE PTAN
TX541353YLP2OtherMEDICARE PTAN