Provider Demographics
NPI:1831345081
Name:OOMMEN, BINDHU (MD)
Entity type:Individual
Prefix:
First Name:BINDHU
Middle Name:
Last Name:OOMMEN
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 1:4215 JOE RAMSEY BLVD E STE 220
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7852
Mailing Address - Country:US
Mailing Address - Phone:903-408-5770
Mailing Address - Fax:903-408-5779
Practice Address - Street 1:4215 JOE RAMSEY BLVD E STE 220
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7852
Practice Address - Country:US
Practice Address - Phone:903-408-5770
Practice Address - Fax:903-408-5779
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00094208600000X
TXQ4660208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FV279OtherBCBS PROVIDER NUMBER
NC1831345081Medicaid
TX356201901Medicaid
TXP01621610OtherRAILROAD MEDICARE PROVIDER NUMBER
NC1831345081Medicaid
TX472567YMPGMedicare PIN
NCNCD511BMedicare PIN