=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437280971
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRASANNA VENKATESH KUMAR M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1729 BURRSTONE RD
-----------------------------------------------------
City | NEW HARTFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13413-1001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-798-1508
-----------------------------------------------------
Fax | 315-624-1963
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1729 BURRSTONE RD
-----------------------------------------------------
City | NEW HARTFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13413-1001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-798-1508
-----------------------------------------------------
Fax | 315-624-1963
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | 277527
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 277527
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------