Healthcare Provider Details

I. General information

NPI: 1346507134
Provider Name (Legal Business Name): AHILA LAKSHMI KUGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AHILA LAKSHMI KUMAR

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3521 SILVERSIDE RD STE 1F
WILMINGTON DE
19810-4900
US

IV. Provider business mailing address

401 ROUTE 73 N BLDG 10
MARLTON NJ
08053-3425
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-2613
  • Fax:
Mailing address:
  • Phone: 856-872-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD455542
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0024386
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: