Provider Demographics
NPI:1164474425
Name:KUMAR, SUBHASH (MD)
Entity Type:Individual
Prefix:
First Name:SUBHASH
Middle Name:
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 1:749 SHIVEL LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-3842
Mailing Address - Country:US
Mailing Address - Phone:304-529-2090
Mailing Address - Fax:304-522-2658
Practice Address - Street 1:1656 13TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3829
Practice Address - Country:US
Practice Address - Phone:304-529-2090
Practice Address - Fax:304-522-2658
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D49343Medicare UPIN
WVKU0498535Medicare ID - Type Unspecified