Provider Demographics
NPI:1003976598
Name:KUSUMA, SHARAT KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SHARAT
Middle Name:KUMAR
Last Name:KUSUMA
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 1:5350 FRANTZ RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 E TOWN ST
Practice Address - Street 2:SUITE 7-250
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4600
Practice Address - Country:US
Practice Address - Phone:614-566-8570
Practice Address - Fax:614-566-8548
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117745207XS0114X
NHLT 2791207X00000X
OH35093375207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2939557Medicaid
NH30208278Medicaid
NHP00684097Medicare PIN
OHKU4263841Medicare PIN
NH000917401Medicare PIN