Provider Demographics
NPI:1811000631
Name:KUMARESAN, VASUMATHY KANDALLU (MD,)
Entity Type:Individual
Prefix:
First Name:VASUMATHY
Middle Name:KANDALLU
Last Name:KUMARESAN
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 1:3833 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-5863
Mailing Address - Country:US
Mailing Address - Phone:610-691-0404
Mailing Address - Fax:
Practice Address - Street 1:3833 LINDEN ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-5863
Practice Address - Country:US
Practice Address - Phone:610-691-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH21269Medicare UPIN