Provider Demographics
NPI:1619403987
Name:KUMAR, SATESH (MD)
Entity Type:Individual
Prefix:
First Name:SATESH
Middle Name:
Last Name:KUMAR
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 1:24 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6099
Mailing Address - Country:US
Mailing Address - Phone:203-739-6959
Mailing Address - Fax:203-749-9031
Practice Address - Street 1:24 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6099
Practice Address - Country:US
Practice Address - Phone:203-739-6959
Practice Address - Fax:203-749-9031
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2020-06-11
Deactivation Date:2017-12-08
Deactivation Code:
Reactivation Date:2017-12-19
Provider Licenses
StateLicense IDTaxonomies
CT65859208M00000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT65859OtherCT DEPARTMENT OF PUBLIC HEALTH MEDICAL LICENSE