Healthcare Provider Details

I. General information

NPI: 1073616652
Provider Name (Legal Business Name): SURENDRA M KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MERCANTILE LN STE 135
LARGO MD
20774-5380
US

IV. Provider business mailing address

1100 MERCANTILE LN STE 135
LARGO MD
20774-5380
US

V. Phone/Fax

Practice location:
  • Phone: 301-773-9700
  • Fax:
Mailing address:
  • Phone: 301-773-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0032224
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD32224
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0032224
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: