Healthcare Provider Details

I. General information

NPI: 1326032152
Provider Name (Legal Business Name): VIJAY V KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 LANDMARK DR SUITE 122
GLEN BURNIE MD
21061-4983
US

IV. Provider business mailing address

1589 SULPHUR SPRING RD SUITE 109
BALTIMORE MD
21227-2542
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-3588
  • Fax: 410-760-3604
Mailing address:
  • Phone: 410-536-5400
  • Fax: 410-737-2168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD80317
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: