Provider Demographics
NPI:1588663942
Name:KUMAR, PREETHI (MD)
Entity Type:Individual
Prefix:
First Name:PREETHI
Middle Name:
Last Name:KUMAR
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:P.O. BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19723-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4000
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:910 FOULK ROAD,
Practice Address - Street 2:SUITE 101
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3157
Practice Address - Country:US
Practice Address - Phone:302-655-3242
Practice Address - Fax:302-655-5392
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006091208000000X
DEC10006091208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001058901Medicaid
DEH46783Medicare UPIN
DE0001058901Medicaid