Provider Demographics
NPI:1225646136
Name:KUMAR, AGARA SRINIVASAGAGAN
Entity Type:Individual
Prefix:MR
First Name:AGARA SRINIVASAGAGAN
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:A S GAGAN
Other - Middle Name:
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:24 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6077
Mailing Address - Country:US
Mailing Address - Phone:734-419-1951
Mailing Address - Fax:
Practice Address - Street 1:24 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6077
Practice Address - Country:US
Practice Address - Phone:203-739-4902
Practice Address - Fax:203-739-1899
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351046258207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine