Provider Demographics
NPI:1376594432
Name:KUMUD S TRIPATHY AND ASSOCIATES
Entity type:Organization
Organization Name:KUMUD S TRIPATHY AND ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KUMUD
Authorized Official - Middle Name:S
Authorized Official - Last Name:TRIPATHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-776-2000
Mailing Address - Street 1:2215 E VILLA MARIA RD
Mailing Address - Street 2:110
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2548
Mailing Address - Country:US
Mailing Address - Phone:979-776-2000
Mailing Address - Fax:979-776-0427
Practice Address - Street 1:2215 E VILLA MARIA RD
Practice Address - Street 2:110
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2548
Practice Address - Country:US
Practice Address - Phone:979-776-2000
Practice Address - Fax:979-776-0427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081197801Medicaid
TX0081AUOtherBLUE CROSS GROUP #
TXDC9760OtherMEDICARE RAILROAD GROUP #
TX081197801Medicaid