Healthcare Provider Details

I. General information

NPI: 1962077057
Provider Name (Legal Business Name): BRINDA PRASANNA KUMAR MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date: 11/14/2022
Reactivation Date: 04/11/2024

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-8600
  • Fax:
Mailing address:
  • Phone: 802-847-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number042.0019230-COMP
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: