Healthcare Provider Details

I. General information

NPI: 1558892653
Provider Name (Legal Business Name): PRIYANKA KUMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 W MAIN ST
CHARLOTTESVILLE VA
22903-2824
US

IV. Provider business mailing address

4659 SNOW GOOSE LN
GLEN ALLEN VA
23060-6291
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-2500
  • Fax:
Mailing address:
  • Phone: 832-573-6356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101281525
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number24143053
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number0101281525
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: