Basic Information
Provider Information
NPI: 1184005654
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KUMAR
FirstName: AMEET
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1705 TARBORO ST SW
Address2:  
City: WILSON
State: NC
PostalCode: 278933428
CountryCode: US
TelephoneNumber: 2523998040
FaxNumber:  
Practice Location
Address1: 1705 TARBORO ST SW
Address2:  
City: WILSON
State: NC
PostalCode: 27893
CountryCode: US
TelephoneNumber: 2523998040
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/10/2015
LastUpdateDate: 12/20/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/20/2019

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD468977PAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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