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MAMUKA KHUNDADZE M.D.
NPI 1760368526
Student in an Organized Health Care Education/Training Program in Annapolis, MD

Active since August 14, 2025PECOS Enrolled
2003 MEDICAL PARKWAY, SUITE 350, ANNAPOLIS, MD 21401(443) 951-4286(443) 949-7380 Get Directions Write a Review

NPPES record last updated: December 5, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Dec 5, 2025, Aug 14, 2025 (2 updates tracked since 2025).

About Mamuka Khundadze M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAMUKA KHUNDADZE M.D. (NPI 1760368526) is an individual student in an organized health care education/training program in Annapolis, Maryland and active in the NPI registry since August 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1760368526
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameMAMUKA KHUNDADZECredential: M.D.
Location Address2003 MEDICAL PARKWAY, SUITE 350Annapolis, MD 21401
Mailing Address2003 Medical Parkway, Suite 350Annapolis, MD 21401 · (443) 951-4286 · Fax (443) 949-7380
Phone(443) 951-4286
Fax(443) 949-7380
Sole ProprietorNo
Enumeration DateAugust 14, 2025
Last NPPES UpdateDecember 5, 20252 updates tracked since enumeration
NPPES CertifiedDecember 5, 2025
✔ NPI 1760368526 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
2003 MEDICAL PARKWAY, SUITE 350, Annapolis, MD 21401
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mamuka Khundadze M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MOHAMMAD WAQAS DANISH MD
Student in an Organized Health Care Education/Training Program
2003 MEDICAL PARKWAY, SUITE 350
ANNAPOLIS, MD 21401
Anne Arundel County (443) 951-4286

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mamuka Khundadze's NPI number?

The NPI number for Mamuka Khundadze is 1760368526. It was assigned to this individual provider in the NPPES registry on August 14, 2025.

Where is Mamuka Khundadze located?

Mamuka Khundadze practices at 2003 Medical Parkway, Suite 350, Annapolis, MD 21401. The listed phone number is (443) 951-4286.

What is Mamuka Khundadze's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Mamuka Khundadze enrolled in Medicare?

Yes. Mamuka Khundadze is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Mamuka Khundadze was last updated on December 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.