Healthcare Provider Details

I. General information

NPI: 1598930018
Provider Name (Legal Business Name): T.KUMAR PENDURTHI SURGICAL ASSOCIATES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FAIRVIEW ST
BETHLEHEM PA
18017-8923
US

IV. Provider business mailing address

3600 FAIRVIEW ST
BETHLEHEM PA
18017-8923
US

V. Phone/Fax

Practice location:
  • Phone: 610-882-0199
  • Fax: 610-882-2814
Mailing address:
  • Phone: 610-882-0199
  • Fax: 610-882-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD055454L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD055454L
License Number StatePA

VIII. Authorized Official

Name: DR. KUMAR T PENDURTHI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 610-882-0199