Basic Information
| Provider Information | |||||||||
| NPI: | 1902100217 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KUMUDA R PRADHAN MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 GATEWAY BLVD W | ||||||||
| Address2: | 120 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799253331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157745557 | ||||||||
| FaxNumber: | 9157716496 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 N OREGON ST | ||||||||
| Address2: | 620 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799023584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157791716 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2010 | ||||||||
| LastUpdateDate: | 12/29/2010 | ||||||||
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| AuthorizedOfficialLastName: | PRADHAN | ||||||||
| AuthorizedOfficialFirstName: | KUMUDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9157791716 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | N5950 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.