Healthcare Provider Details

I. General information

NPI: 1437326915
Provider Name (Legal Business Name): DHIRENDRA KUMAR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SHARPE ST
KINGSTON PA
18704-3715
US

IV. Provider business mailing address

4018 166TH AVE NE
REDMOND WA
98052-5400
US

V. Phone/Fax

Practice location:
  • Phone: 570-552-8900
  • Fax:
Mailing address:
  • Phone: 224-766-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT193263
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: