Healthcare Provider Details

I. General information

NPI: 1093769507
Provider Name (Legal Business Name): SUBHASH KUMAR M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 13TH AVE
HUNTINGTON WV
25701-3829
US

IV. Provider business mailing address

1656 13TH AVE
HUNTINGTON WV
25701-3829
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 Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUBHASH KUMAR
Title or Position: OWNER
Credential: M.D.
Phone: 304-529-2090