Healthcare Provider Details

I. General information

NPI: 1427618719
Provider Name (Legal Business Name): VASUPRADHA SURESH KUMAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GEORGE WASHINGTON HWY STE 104
LINCOLN RI
02865-4299
US

IV. Provider business mailing address

117 ELLENFIELD ST STE 101
PROVIDENCE RI
02905-4541
US

V. Phone/Fax

Practice location:
  • Phone: 401-606-8052
  • Fax: 401-606-8055
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number1024222
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD20717
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: