Healthcare Provider Details

I. General information

NPI: 1760769095
Provider Name (Legal Business Name): KISHORE KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 STATE STREET
MERIDEN CT
06450-3293
US

IV. Provider business mailing address

134 STATE STREET
MERIDEN CT
06450-3293
US

V. Phone/Fax

Practice location:
  • Phone: 203-237-2229
  • Fax: 203-686-1677
Mailing address:
  • Phone: 203-237-2229
  • Fax: 203-686-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number277200
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54847
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: