Healthcare Provider Details

I. General information

NPI: 1831545466
Provider Name (Legal Business Name): DEEPIKA KUMAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 04/03/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CEDAR ST YUSM, DEPARTMENT OF PATHOLOGY
NEW HAVEN CT
06510-3218
US

IV. Provider business mailing address

310 CEDAR ST
NEW HAVEN CT
06510-3218
US

V. Phone/Fax

Practice location:
  • Phone: 203-737-4142
  • Fax:
Mailing address:
  • Phone: 203-785-3624
  • Fax: 203-785-7037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number65095
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number65095
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number65095
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: