Provider Demographics
NPI:1629091608
Name:SIDHARTHA, KUMARA (MD)
Entity Type:Individual
Prefix:
First Name:KUMARA
Middle Name:
Last Name:SIDHARTHA
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 1:297 NORTH ST STE 221
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5133
Mailing Address - Country:US
Mailing Address - Phone:508-862-7777
Mailing Address - Fax:
Practice Address - Street 1:495 STATION AVE
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-1218
Practice Address - Country:US
Practice Address - Phone:508-778-4777
Practice Address - Fax:508-771-9555
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
043369730OtherPRIVATE HEALTHCARE SYSTEM
694622OtherHARVARD PILGRIM
J25418OtherBLUE CROSS
043369730OtherFIRST HEALTH
7390460OtherAETNA
MA0183610Medicaid
215838OtherTUFTS
694622OtherHARVARD PILGRIM
043369730OtherPRIVATE HEALTHCARE SYSTEM
110243454Medicare ID - Type UnspecifiedRAILROAD