Provider Demographics
NPI:1083697320
Name:KUMARI, PARDEEP (MD)
Entity Type:Individual
Prefix:
First Name:PARDEEP
Middle Name:
Last Name:KUMARI
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:PO BOX 11640
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32524
Mailing Address - Country:US
Mailing Address - Phone:850-549-4755
Mailing Address - Fax:850-549-4760
Practice Address - Street 1:2120 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514
Practice Address - Country:US
Practice Address - Phone:850-549-4755
Practice Address - Fax:850-549-4760
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0080464207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258918400Medicaid
FL258918400Medicaid
FL35453ZMedicare ID - Type Unspecified