Provider Demographics
NPI:1407910896
Name:KUMAR, NAMRATA (PA-C)
Entity Type:Individual
Prefix:
First Name:NAMRATA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 E RIVER ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-5935
Mailing Address - Country:US
Mailing Address - Phone:440-322-0872
Mailing Address - Fax:440-322-4991
Practice Address - Street 1:673 E RIVER ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-322-0872
Practice Address - Fax:440-322-4991
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002624RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0079922Medicaid