Provider Demographics
NPI:1407899578
Name:KUMAR, PALLAVI PULLATIKURTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:PALLAVI
Middle Name:PULLATIKURTHI
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-4710
Mailing Address - Fax:410-601-8526
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-4710
Practice Address - Fax:410-601-8526
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057256207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406533600Medicaid
MDC31152OtherR/R MEDICARE GROUP #
MDP00198858OtherR/R MEDICARE PROVIDER #
MDI24598Medicare UPIN