Provider Demographics
NPI:1851499834
Name:KUNDU, MOUSHUMI (MD)
Entity Type:Individual
Prefix:MS
First Name:MOUSHUMI
Middle Name:
Last Name:KUNDU
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 1:250 FAME AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1587
Mailing Address - Country:US
Mailing Address - Phone:717-646-7385
Mailing Address - Fax:717-632-1998
Practice Address - Street 1:250 FAME AVE STE 206A
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1587
Practice Address - Country:US
Practice Address - Phone:717-316-2248
Practice Address - Fax:717-316-7712
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069934L207R00000X, 207RG0300X
DEC10006229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000028556Medicaid
PA102433776Medicaid
PA154601ZEA5Medicare PIN
DEP00087116Medicare PIN
PA102433776Medicaid