Healthcare Provider Details

I. General information

NPI: 1508904939
Provider Name (Legal Business Name): SUSEELA KUMAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 12/17/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DARTMOUTH HITCHCOCK - GERIATRICS
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DARTMOUTH HITCHCOCK - GERIATRICS
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-9500
  • Fax:
Mailing address:
  • Phone: 603-653-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00048659
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number160535
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number17707
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: