Healthcare Provider Details

I. General information

NPI: 1164474425
Provider Name (Legal Business Name): SUBHASH KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 13TH AVE
HUNTINGTON WV
25701-3829
US

IV. Provider business mailing address

749 SHIVEL LN
HUNTINGTON WV
25705-3842
US

V. Phone/Fax

Practice location:
  • Phone: 304-529-2090
  • Fax: 304-522-2658
Mailing address:
  • Phone: 304-529-2090
  • Fax: 304-522-2658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12697
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: