Provider Demographics
NPI:1083619225
Name:KUMAR, SHASHI AM (MD)
Entity Type:Individual
Prefix:DR
First Name:SHASHI
Middle Name:AM
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 1:4030 PEPPERWOOD CIR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6499
Mailing Address - Country:US
Mailing Address - Phone:256-539-6536
Mailing Address - Fax:256-539-1504
Practice Address - Street 1:4030 PEPPERWOOD CIR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6499
Practice Address - Country:US
Practice Address - Phone:256-539-6536
Practice Address - Fax:256-539-1504
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
AL00011996207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051554532Medicare ID - Type Unspecified
ALG26045Medicare UPIN