Provider Demographics
NPI:1245417849
Name:KUMAR, POORNIMA (PAC)
Entity type:Individual
Prefix:
First Name:POORNIMA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 WEST FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1923
Mailing Address - Country:US
Mailing Address - Phone:937-322-1700
Mailing Address - Fax:937-322-8070
Practice Address - Street 1:1416 WEST FIRST STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1923
Practice Address - Country:US
Practice Address - Phone:937-322-1700
Practice Address - Fax:937-322-8070
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
OH50002762363A00000X
PA1075639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant