Active NPI
Sulabha S. Mujumdar, M.D.
- Specialist
- Middlesboro, KY
National Provider Identifier
1669553731
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 19968
- Practice address
- 3601 Cumberland Ave
Middlesboro, KY 40965-2613 - Phone
- (606) 248-3100
- Fax
- (606) 248-4141
- NPI assigned
- Oct 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 19968 | KY | Primary |
Addresses
Primary practice location
3601 Cumberland Ave
Middlesboro, KY 40965-2613
Mailing address
3601 West Cumberland Avenue
P.O. Box 1208
Middlesboro, KY 40965
Phone (606) 248-3100
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0033734 | Other | TN | BLUE CARE/TN CARE SELECT |
| 006234241 | Medicaid | VA | |
| 2196 | Other | KY | CHA |
| 64199680 | Medicaid | KY | |
| 3195877 | Other | TN | TN MEDICAID |
| 000000047394 | Other | KY | BLUE CROSS |
| K04395 | Other | KY | CHAMPUS |
| 1307695 | Other | KY | UMWA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19968 | KY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186012800000",
"number": "1669553731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3601 WEST CUMBERLAND AVENUE",
"address_2": "P.O. BOX 1208",
"city": "MIDDLESBORO",
"state": "KY",
"postal_code": "40965",
"telephone_number": "606-248-3100",
"fax_number": "606-248-4141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 CUMBERLAND AVE",
"city": "MIDDLESBORO",
"state": "KY",
"postal_code": "409652613",
"telephone_number": "606-248-3100",
"fax_number": "606-248-4141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUJUMDAR",
"first_name": "SULABHA",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-17",
"last_updated": "2007-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "KY",
"license": "19968",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE/TN CARE SELECT",
"identifier": "0033734",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "006234241",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHA",
"identifier": "2196",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64199680",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TN MEDICAID",
"identifier": "3195877",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "000000047394",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "K04395",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UMWA",
"identifier": "1307695",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Middlesboro, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.