Provider Demographics
NPI:1861691727
Name:SANTRA, MUGDHA (MD)
Entity type:Individual
Prefix:DR
First Name:MUGDHA
Middle Name:
Last Name:SANTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MUGDHA
Other - Middle Name:
Other - Last Name:SANTRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3205 81ST ST
Mailing Address - Street 2:APT# CC6
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-2042
Mailing Address - Country:US
Mailing Address - Phone:718-426-8581
Mailing Address - Fax:
Practice Address - Street 1:7901 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine