Provider Demographics
NPI:1023217296
Name:NEW BERN MEDICINE AND SPORTS
Entity Type:Organization
Organization Name:NEW BERN MEDICINE AND SPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-635-1699
Mailing Address - Street 1:PO BOX 13727
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-3727
Mailing Address - Country:US
Mailing Address - Phone:252-635-1699
Mailing Address - Fax:252-634-2920
Practice Address - Street 1:1319 S GLENBURNIE RD STE D
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2615
Practice Address - Country:US
Practice Address - Phone:252-633-3744
Practice Address - Fax:252-634-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty