Healthcare Provider Details

I. General information

NPI: 1588828230
Provider Name (Legal Business Name): INDIRA KUMAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 VOORHEES TOWN CENTER
VOORHEES NJ
08043-1910
US

IV. Provider business mailing address

2050 VOORHEES TOWN CENTER
VOORHEES NJ
08043-1910
US

V. Phone/Fax

Practice location:
  • Phone: 856-346-0005
  • Fax: 800-691-4185
Mailing address:
  • Phone: 856-346-0005
  • Fax: 800-691-4185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD 447674
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: