Provider Demographics
NPI:1487675492
Name:SHAILENDRA KUMAR M.D.
Entity Type:Organization
Organization Name:SHAILENDRA KUMAR M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAILENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-699-9513
Mailing Address - Street 1:6510 KENILWORTH AVE
Mailing Address - Street 2:2200
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1339
Mailing Address - Country:US
Mailing Address - Phone:301-699-9513
Mailing Address - Fax:301-864-8565
Practice Address - Street 1:6510 KENILWORTH AVE
Practice Address - Street 2:2200
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1339
Practice Address - Country:US
Practice Address - Phone:301-699-9513
Practice Address - Fax:301-864-8565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018198174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM05021OtherSTATE CDS NUMBER
MDD0063012OtherLIC NUMBER
MD061985OtherUSMLE / ECFMG
MDD0018198OtherLICENCE NUMBER
DCMD6694OtherLICENCE NUMBER
MDBN9440328OtherDEA
DCMD6694OtherLICENCE NUMBER
MDC62044Medicare UPIN
MD145639Medicare ID - Type Unspecified
MDD0063012OtherLIC NUMBER
MD889871Medicare ID - Type Unspecified
MDD0018198OtherLICENCE NUMBER
MDBN9440328OtherDEA