Healthcare Provider Details

I. General information

NPI: 1508915216
Provider Name (Legal Business Name): SANJAY KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 S. GLENBURNIE BLVD. SUITE D
NEW BERN NC
28562
US

IV. Provider business mailing address

PO BOX 13727
NEW BERN NC
28561-3727
US

V. Phone/Fax

Practice location:
  • Phone: 252-635-1699
  • Fax: 252-635-9599
Mailing address:
  • Phone: 252-635-1699
  • Fax: 252-635-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: