Provider Demographics
NPI:1073780953
Name:KUMAR, SANJEEV (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SANJEEV
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 FAIRBROOK RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1652
Mailing Address - Country:US
Mailing Address - Phone:734-474-3708
Mailing Address - Fax:
Practice Address - Street 1:7601 FAIRBROOK RD
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-1652
Practice Address - Country:US
Practice Address - Phone:734-474-3708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-10
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004613363AM0700X
MDC0005442363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601004613OtherMI PHYSICIAN ASSISTANT PERMANENT ID NUMBER
MDC0005442OtherMARYLAND STATE LICENSE