Provider Demographics
NPI:1760551170
Name:KUMAR, PADMA BHAGAVATULA (MD)
Entity Type:Individual
Prefix:
First Name:PADMA
Middle Name:BHAGAVATULA
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 1:100 INTREPID LANE, STE 5
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205
Mailing Address - Country:US
Mailing Address - Phone:315-498-5430
Mailing Address - Fax:315-299-5138
Practice Address - Street 1:AUSTIN VA OUT PATIENT MEDICAL CENTER
Practice Address - Street 2:7901 METROPOLIS DR
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744
Practice Address - Country:US
Practice Address - Phone:315-450-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ62222084B0040X, 2084N0400X
NY213851-12084N0008X, 2084S0012X
NY2138512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01948461Medicaid
NY130021183Medicare PIN
NYG77124Medicare UPIN
NY01948461Medicaid