1760551170 NPI number — PADMA BHAGAVATULA KUMAR M.D.

Table of content: PADMA BHAGAVATULA KUMAR M.D. (NPI 1760551170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760551170 NPI number — PADMA BHAGAVATULA KUMAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUMAR
Provider First Name:
PADMA
Provider Middle Name:
BHAGAVATULA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760551170
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 INTREPID LANE, STE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-498-5430
Provider Business Mailing Address Fax Number:
315-299-5138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AUSTIN VA OUT PATIENT MEDICAL CENTER
Provider Second Line Business Practice Location Address:
7901 METROPOLIS DR
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-450-6049
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084B0040X , with the licence number:  Q6222 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0008X , with the licence number: 213851-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: Q6222 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084S0012X , with the licence number: 213851-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 213851 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01948461 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".