Basic Information
| Provider Information | |||||||||
| NPI: | 1851499834 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUNDU | ||||||||
| FirstName: | MOUSHUMI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 250 FAME AVE | ||||||||
| Address2: | SUITE 235 | ||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173311587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176467385 | ||||||||
| FaxNumber: | 7176321998 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 FAME AVE STE 206A | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173311587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173162248 | ||||||||
| FaxNumber: | 7173167712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD069934L | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | C10006229 | DE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | MD069934L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1000028556 | 05 | DE | MEDICAID | 102433776 | 05 | PA | MEDICAID |