Provider Demographics
NPI:1043431554
Name:BAKSHI, MONA (MD)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:BAKSHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:BAKSHI
Other - Last Name:KAMATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-1000
Mailing Address - Country:US
Mailing Address - Phone:334-756-4860
Mailing Address - Fax:
Practice Address - Street 1:267 FOB JAMES DR
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-5077
Practice Address - Country:US
Practice Address - Phone:334-756-4860
Practice Address - Fax:334-756-4866
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91095207Q00000X
ALMD.28420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine