Basic Information
Provider Information
NPI: 1518141597
EntityType: 2
ReplacementNPI:  
OrganizationName: VIJAY KUMAR MD PA
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
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Mailing Information
Address1: 3070 COLLEGE ST
Address2: SUITE 300
City: BEAUMONT
State: TX
PostalCode: 777014691
CountryCode: US
TelephoneNumber: 4098131677
FaxNumber:  
Practice Location
Address1: 3070 COLLEGE ST
Address2: SUITE 300
City: BEAUMONT
State: TX
PostalCode: 777014691
CountryCode: US
TelephoneNumber: 4098131677
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/26/2007
LastUpdateDate: 12/26/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: KUMAR
AuthorizedOfficialFirstName: VIJAY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: RHEUMATOLOGY SPECIALIST
AuthorizedOfficialTelephone: 4098131677
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MEDICAL DOCTOR
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000XH76708TXY193200000X MULTI-SPECIALTY GROUPOther Service ProvidersSpecialist 

No ID Information.


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