Healthcare Provider Details

I. General information

NPI: 1740431212
Provider Name (Legal Business Name): ABHISHEK KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST UVM MEDICAL CENTER - NEPHROLOGY
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

800 HOWARD AVE
NEW HAVEN CT
06519-1369
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3572
  • Fax: 802-847-3607
Mailing address:
  • Phone: 203-785-2585
  • Fax: 203-785-7317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39534
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.053928
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number042.0013476
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number55316
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: