Healthcare Provider Details

I. General information

NPI: 1912527862
Provider Name (Legal Business Name): TEJAS NIMBA NIKUMBH MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S WASHINGTON AVE
SCRANTON PA
18505-3814
US

IV. Provider business mailing address

550 UNIVERSITY BLVD # UH4601
INDIANAPOLIS IN
46202-5149
US

V. Phone/Fax

Practice location:
  • Phone: 570-591-5153
  • Fax:
Mailing address:
  • Phone: 317-944-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number83540
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number83540
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: