Provider Demographics
NPI:1760443089
Name:MAZUMDER, SEBA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SEBA
Middle Name:
Last Name:MAZUMDER
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 1:140 FRONT ST SUITE #4
Mailing Address - Street 2:
Mailing Address - City:GILBERTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:36908
Mailing Address - Country:US
Mailing Address - Phone:251-843-5537
Mailing Address - Fax:251-843-5354
Practice Address - Street 1:140 FRONT ST SUITE #4
Practice Address - Street 2:
Practice Address - City:GILBERTOWN
Practice Address - State:AL
Practice Address - Zip Code:36908
Practice Address - Country:US
Practice Address - Phone:251-843-5537
Practice Address - Fax:251-843-5354
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00004467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF07534Medicare UPIN