Provider Demographics
NPI:1003813015
Name:KUMAR, NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 NW EDENBOWER BLVD STE 176
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8830
Mailing Address - Country:US
Mailing Address - Phone:541-957-1133
Mailing Address - Fax:541-957-1799
Practice Address - Street 1:2410 NW EDENBOWER BLVD STE 176
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8830
Practice Address - Country:US
Practice Address - Phone:541-957-1133
Practice Address - Fax:541-957-1799
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2023-02-24
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
ORMD23318207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286437Medicaid
ORR113535Medicare PIN
OR286437Medicaid