Provider Demographics
NPI:1104805803
Name:MAITRA, SHYAMAL KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:SHYAMAL
Middle Name:KUMAR
Last Name:MAITRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:714 MOCKINGBIRD PL
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-7521
Mailing Address - Country:US
Mailing Address - Phone:530-758-8254
Mailing Address - Fax:
Practice Address - Street 1:2280 HARRISON AVE STE B
Practice Address - Street 2:C/O EURKA INTERNAL MEDICINE
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3200
Practice Address - Country:US
Practice Address - Phone:707-443-9371
Practice Address - Fax:707-443-2620
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52642207R00000X
CT028767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine