Provider Demographics
NPI:1356332316
Name:KUMAR, VINAYSHREE (PA C)
Entity Type:Individual
Prefix:
First Name:VINAYSHREE
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:VINAYSHREE
Other - Middle Name:
Other - Last Name:WADHAWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 LOWTHER ST
Mailing Address - Street 2:INTERNISTS OF CENTRAL PA LTD
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-2045
Mailing Address - Country:US
Mailing Address - Phone:717-774-1366
Mailing Address - Fax:717-774-4232
Practice Address - Street 1:108 LOWTHER ST
Practice Address - Street 2:INTERNISTS OF CENTRAL PA LTD
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-2045
Practice Address - Country:US
Practice Address - Phone:717-774-1366
Practice Address - Fax:717-774-4232
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051810363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
088821E9JMedicare ID - Type Unspecified
Q22870Medicare UPIN