Provider Demographics
NPI:1922188390
Name:KUMBALA, DAMODAR REDDY (MD)
Entity Type:Individual
Prefix:
First Name:DAMODAR
Middle Name:REDDY
Last Name:KUMBALA
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 1:5131 ODONOVAN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4791
Mailing Address - Country:US
Mailing Address - Phone:225-767-4893
Mailing Address - Fax:225-767-5494
Practice Address - Street 1:5131 ODONOVAN DR STE 100
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4791
Practice Address - Country:US
Practice Address - Phone:225-767-4893
Practice Address - Fax:225-767-5494
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202414207RN0300X, 208M00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04138518Medicaid
LA1316598Medicaid
LA4N464Medicare PIN
MS04138518Medicaid