Healthcare Provider Details

I. General information

NPI: 1548362742
Provider Name (Legal Business Name): REETIKA KUMAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST SUITE 701
PHILADELPHIA PA
19107-4414
US

IV. Provider business mailing address

615 CHESTNUT ST 14TH FLOOR, CENTRAL ENROLLMENTS
PHILADELPHIA PA
19106-4404
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6180
  • Fax: 215-955-6410
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD430000
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: