Provider Demographics
NPI:1043393986
Name:KUMAR, RAJAPURAM RAVINDRA (MD)
Entity Type:Individual
Prefix:
First Name:RAJAPURAM
Middle Name:RAVINDRA
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 1:780 W OLIVE AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348
Mailing Address - Country:US
Mailing Address - Phone:209-723-0783
Mailing Address - Fax:209-723-9452
Practice Address - Street 1:780 W OLIVE AVE
Practice Address - Street 2:STE 103
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348
Practice Address - Country:US
Practice Address - Phone:209-723-0783
Practice Address - Fax:209-723-9452
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36528207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A365282Medicaid
CA00A365282Medicare PIN
CA00A365282Medicaid