1003813015 NPI number — DR. NEIL KUMAR MD

Table of content: DR. NEIL KUMAR MD (NPI 1003813015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003813015 NPI number — DR. NEIL KUMAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUMAR
Provider First Name:
NEIL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1003813015
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/20/2006
NPI Reactivation Date:
03/30/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1632 NW EDENBOWER BLVD
Provider Second Line Business Mailing Address:
SUITE 176
Provider Business Mailing Address City Name:
ROSEBURG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97470-8899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-957-1133
Provider Business Mailing Address Fax Number:
541-957-1799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2510 NW EDENBOWER BLVD
Provider Second Line Business Practice Location Address:
SUITE # 176
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97471-8899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-957-1133
Provider Business Practice Location Address Fax Number:
541-957-1799
Provider Enumeration Date:
07/05/2005

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: 174400000X , with the licence number:  MD23318 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 286437 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com