Healthcare Provider Details

I. General information

NPI: 1295759819
Provider Name (Legal Business Name): KUMKUM AHLUWALIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 W SPROUL RD HEALTHPLEX SUITE 205
SPRINGFIELD PA
19064
US

IV. Provider business mailing address

301 LINDENWOOD DRIVE SUITE 350
MALVERN PA
19355
US

V. Phone/Fax

Practice location:
  • Phone: 610-604-0888
  • Fax: 610-604-0880
Mailing address:
  • Phone: 215-590-2897
  • Fax: 215-590-0325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-062578-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: