Provider Demographics
NPI:1598930018
Name:T.KUMAR PENDURTHI SURGICAL ASSOCIATES,LLC
Entity Type:Organization
Organization Name:T.KUMAR PENDURTHI SURGICAL ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KUMAR
Authorized Official - Middle Name:T
Authorized Official - Last Name:PENDURTHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-882-0199
Mailing Address - Street 1:3600 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8923
Mailing Address - Country:US
Mailing Address - Phone:610-882-0199
Mailing Address - Fax:610-882-2814
Practice Address - Street 1:3600 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8923
Practice Address - Country:US
Practice Address - Phone:610-882-0199
Practice Address - Fax:610-882-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055454L208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty