Basic Information
| Provider Information | |||||||||
| NPI: | 1356332316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUMAR | ||||||||
| FirstName: | VINAYSHREE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA C | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | WADHAWAN | ||||||||
| OtherFirstName: | VINAYSHREE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 108 LOWTHER ST | ||||||||
| Address2: | INTERNISTS OF CENTRAL PA LTD | ||||||||
| City: | LEMOYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170432045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177741366 | ||||||||
| FaxNumber: | 7177744232 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 LOWTHER ST | ||||||||
| Address2: | INTERNISTS OF CENTRAL PA LTD | ||||||||
| City: | LEMOYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170432045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177741366 | ||||||||
| FaxNumber: | 7177744232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA051810 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.