Provider Demographics
NPI:1164536264
Name:KUMAR, CHANDRA MOHAN (MD)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:MOHAN
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 1:208 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1160
Mailing Address - Country:US
Mailing Address - Phone:304-343-4300
Mailing Address - Fax:304-343-5473
Practice Address - Street 1:208 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-1160
Practice Address - Country:US
Practice Address - Phone:304-343-4300
Practice Address - Fax:304-343-5473
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11875207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0112177000Medicaid
D49302Medicare UPIN
WVKU0463626Medicare ID - Type UnspecifiedLOGAN, WV OFFICE
WVKU0463625Medicare ID - Type UnspecifiedRIPLEY, WV OFFICE
WVKU0463622Medicare ID - Type UnspecifiedBECKLEY, WV OFFICE
WVKU0463624Medicare ID - Type UnspecifiedPARKERSBURG, WV OFFICE
WV0112177000Medicaid