Healthcare Provider Details

I. General information

NPI: 1316333289
Provider Name (Legal Business Name): ANAND MOHAN KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST TMP 3
NEW HAVEN CT
06510
US

IV. Provider business mailing address

333 CEDAR ST TMP 3
NEW HAVEN CT
06510
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2802
  • Fax: 203-785-6664
Mailing address:
  • Phone: 203-785-2802
  • Fax: 203-785-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number294932
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: