Provider Demographics
NPI:1730116328
Name:KAUR, MANDY (MD)
Entity type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:
Last Name:KAUR
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 1:274 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3611
Mailing Address - Country:US
Mailing Address - Phone:781-944-8960
Mailing Address - Fax:781-944-8977
Practice Address - Street 1:274 MAIN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3611
Practice Address - Country:US
Practice Address - Phone:781-944-8960
Practice Address - Fax:781-944-8977
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6178022Medicaid
MAB73140Medicare UPIN
MAB40085Medicare ID - Type Unspecified