Provider Demographics
NPI:1437367521
Name:KUMARESAN, JEEVITH ISVERIYA (MD)
Entity Type:Individual
Prefix:DR
First Name:JEEVITH
Middle Name:ISVERIYA
Last Name:KUMARESAN
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 1:45 CLOVER DR
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648
Mailing Address - Country:US
Mailing Address - Phone:973-930-1075
Mailing Address - Fax:
Practice Address - Street 1:45 CLOVER DR
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-2509
Practice Address - Country:US
Practice Address - Phone:973-930-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436972208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics