Provider Demographics
NPI:1356321087
Name:SUKUMAR, VENKATARAMAN R (MD)
Entity Type:Individual
Prefix:
First Name:VENKATARAMAN
Middle Name:R
Last Name:SUKUMAR
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 1:1253 COLLEGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-8713
Mailing Address - Country:US
Mailing Address - Phone:302-677-0000
Mailing Address - Fax:
Practice Address - Street 1:1253 COLLEGE PARK DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-8713
Practice Address - Country:US
Practice Address - Phone:302-677-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100042322085R0204X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE402788D69Medicare PIN