Provider Demographics
NPI:1437280971
Name:KUMAR, PRASANNA VENKATESH (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASANNA
Middle Name:VENKATESH
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 1:1729 BURRSTONE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1001
Mailing Address - Country:US
Mailing Address - Phone:315-798-1508
Mailing Address - Fax:315-624-1963
Practice Address - Street 1:1729 BURRSTONE RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1001
Practice Address - Country:US
Practice Address - Phone:315-798-1508
Practice Address - Fax:315-624-1963
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277527207RI0011X
IL036112319207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY277527OtherLICENSE
NY03972007Medicaid
NY277527OtherLICENSE
ILK27218Medicare ID - Type Unspecified
ILI51704Medicare UPIN
MNENROLLEDMedicaid
IL036112319Medicaid