Healthcare Provider Details

I. General information

NPI: 1922259431
Provider Name (Legal Business Name): SUMIT KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 N 52ND ST STE S-3
PHILADELPHIA PA
19131
US

IV. Provider business mailing address

1575 N 52ND ST STE S-3
PHILADELPHIA PA
19131-4736
US

V. Phone/Fax

Practice location:
  • Phone: 264-930-4858
  • Fax: 305-698-6536
Mailing address:
  • Phone: 264-930-4858
  • Fax: 305-698-6536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD443572
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: