1487675492 NPI number — SHAILENDRA KUMAR M.D.

Table of content: (NPI 1487675492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487675492 NPI number — SHAILENDRA KUMAR M.D.

Organization/Personal Information

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

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:
1487675492
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6510 KENILWORTH AVE
Provider Second Line Business Mailing Address:
2200
Provider Business Mailing Address City Name:
RIVERDALE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20737-1339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-699-9513
Provider Business Mailing Address Fax Number:
301-864-8565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6510 KENILWORTH AVE
Provider Second Line Business Practice Location Address:
2200
Provider Business Practice Location Address City Name:
RIVERDALE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20737-1339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-699-9513
Provider Business Practice Location Address Fax Number:
301-864-8565
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KUMAR
Authorized Official First Name:
SHAILENDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
301-699-9513

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D0018198 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: M05021 . This is a "STATE CDS NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: D0063012 . This is a "LIC NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 061985 . This is a "USMLE / ECFMG" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: D0018198 . This is a "LICENCE NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: MD6694 . This is a "LICENCE NUMBER" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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