Provider Demographics
NPI:1689187874
Name:G.M. MAJMUNDAR PSC
Entity Type:Organization
Organization Name:G.M. MAJMUNDAR PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DR
Authorized Official - Prefix:MR
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJMUNDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-285-9000
Mailing Address - Street 1:PO BOX 828
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:KY
Mailing Address - Zip Code:41649-0828
Mailing Address - Country:US
Mailing Address - Phone:606-285-9000
Mailing Address - Fax:
Practice Address - Street 1:11217 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649
Practice Address - Country:US
Practice Address - Phone:606-285-9000
Practice Address - Fax:606-285-9484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAM7953537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty