Provider Demographics
NPI:1568872257
Name:KUMARAN, MARUTI K (MD)
Entity Type:Individual
Prefix:DR
First Name:MARUTI
Middle Name:K
Last Name:KUMARAN
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 1:2450W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129
Mailing Address - Country:US
Mailing Address - Phone:215-707-7237
Mailing Address - Fax:217-707-9389
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-7237
Practice Address - Fax:215-707-9389
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2022-07-21
Deactivation Date:2014-12-04
Deactivation Code:
Reactivation Date:2016-10-07
Provider Licenses
StateLicense IDTaxonomies
MA2664592085R0202X
390200000X
PAMD4605272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program