Provider Demographics
NPI:1326004649
Name:KUMAR, YELLAMRAJU RAVI (MD)
Entity Type:Individual
Prefix:
First Name:YELLAMRAJU
Middle Name:RAVI
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 1:12845 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-1223
Mailing Address - Country:US
Mailing Address - Phone:716-937-3255
Mailing Address - Fax:716-204-7481
Practice Address - Street 1:12845 BROADWAY
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-1223
Practice Address - Country:US
Practice Address - Phone:716-937-3255
Practice Address - Fax:716-204-7481
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01902074Medicaid
NYRA2418Medicare ID - Type Unspecified
NY01902074Medicaid