Provider Demographics
NPI:1033526603
Name:KUMBAR, VIJAY S (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:S
Last Name:KUMBAR
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 1:540 N CLEVELAND AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9846
Mailing Address - Country:US
Mailing Address - Phone:614-891-4705
Mailing Address - Fax:614-568-8050
Practice Address - Street 1:540 N CLEVELAND AVE STE 250
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9846
Practice Address - Country:US
Practice Address - Phone:614-891-4705
Practice Address - Fax:614-568-8050
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI67591208000000X
OH35.138744208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0409269Medicaid