Healthcare Provider Details

I. General information

NPI: 1538461199
Provider Name (Legal Business Name): MANIL KUKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LAMB CIR
CHRISTIANSBURG VA
24073-6344
US

IV. Provider business mailing address

2900 LAMB CIR
CHRISTIANSBURG VA
24073-6344
US

V. Phone/Fax

Practice location:
  • Phone: 540-731-2531
  • Fax:
Mailing address:
  • Phone: 540-731-2531
  • Fax: 540-731-5264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101254617
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: