Provider Demographics
NPI:1184616849
Name:KUMAR, VINAY K (MD)
Entity type:Individual
Prefix:
First Name:VINAY
Middle Name:K
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 1:2070 US HIGHWAY 1 STE 103
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3745
Mailing Address - Country:US
Mailing Address - Phone:321-632-0552
Mailing Address - Fax:321-632-1684
Practice Address - Street 1:2070 US HIGHWAY 1 STE 103
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3745
Practice Address - Country:US
Practice Address - Phone:321-632-0552
Practice Address - Fax:321-632-1684
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258116700Medicaid
FLE3849XOtherMEDICARE PTAN
FL35420OtherBCBS
FL35420OtherBCBS