Basic Information
| Provider Information | |||||||||
| NPI: | 1922259431 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUMAR | ||||||||
| FirstName: | SUMIT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1575 N 52ND ST STE S-3 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191314736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2649304858 | ||||||||
| FaxNumber: | 3056986536 | ||||||||
| Practice Location | |||||||||
| Address1: | 1575 N 52ND ST STE S-3 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2649304858 | ||||||||
| FaxNumber: | 3056986536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2008 | ||||||||
| LastUpdateDate: | 08/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD443572 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0436844 | 05 | NJ | MEDICAID | 1029845580001 | 05 | PA | MEDICAID |