Healthcare Provider Details

I. General information

NPI: 1194072090
Provider Name (Legal Business Name): SHUBHADA KUMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 10/02/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SUNSET LN
CULPEPER VA
22701-3917
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 703-396-5292
  • Fax: 703-396-5297
Mailing address:
  • Phone: 703-396-5292
  • Fax: 703-396-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101252552
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101252552
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: