Basic Information
| Provider Information | |||||||||
| NPI: | 1265698930 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUMAR | ||||||||
| FirstName: | SANJEEV | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1970 ROANOKE BLVD | ||||||||
| Address2: | 116A7 | ||||||||
| City: | SALEM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241536404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409822463 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5400 BERNARD DR | ||||||||
| Address2: | F-205 | ||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240180929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407652268 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2008 | ||||||||
| LastUpdateDate: | 08/01/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 0116020075 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.