Provider Demographics
NPI:1467486977
Name:KUMAR, JAGADEESH SV (MD)
Entity Type:Individual
Prefix:
First Name:JAGADEESH
Middle Name:SV
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 1:216 E PULASKI HWY
Mailing Address - Street 2:125
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6497
Mailing Address - Country:US
Mailing Address - Phone:443-485-6614
Mailing Address - Fax:410-286-1700
Practice Address - Street 1:216 E PULASKI HWY
Practice Address - Street 2:125
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6497
Practice Address - Country:US
Practice Address - Phone:443-485-6614
Practice Address - Fax:410-286-1700
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD67588207N00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ867418Medicaid
AZZ116022OtherGROUP #
AZ109133Medicare ID - Type Unspecified
AZ867418Medicaid