Provider Demographics
NPI:1518915701
Name:KANSUPADA, BINDUKUMAR C (MD)
Entity Type:Individual
Prefix:DR
First Name:BINDUKUMAR
Middle Name:C
Last Name:KANSUPADA
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 1:1117 KENNETH LN
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4062
Mailing Address - Country:US
Mailing Address - Phone:267-334-4611
Mailing Address - Fax:
Practice Address - Street 1:1117 KENNETH LN
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-4062
Practice Address - Country:US
Practice Address - Phone:267-334-4611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030044E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5345103Medicaid
PA0009598580009Medicaid
PA0009598580009Medicaid
PA057349ML9Medicare ID - Type Unspecified
NJ079426SQ1Medicare ID - Type Unspecified