Provider Demographics
NPI:1043268691
Name:KUMAR, PRATHIBHA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATHIBHA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2543 DIXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1860
Mailing Address - Country:US
Mailing Address - Phone:203-230-4160
Mailing Address - Fax:203-848-2484
Practice Address - Street 1:2543 DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1860
Practice Address - Country:US
Practice Address - Phone:203-230-4160
Practice Address - Fax:203-848-2484
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF75221Medicare UPIN