Provider Demographics
NPI:1801809868
Name:KISHORE KUMAR, RANGANNA (MD)
Entity type:Individual
Prefix:
First Name:RANGANNA
Middle Name:
Last Name:KISHORE KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RANGANNA
Other - Middle Name:
Other - Last Name:KISHORE-KUMAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:121 MOUNTAIN OAKS RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-6027
Mailing Address - Country:US
Mailing Address - Phone:215-295-6899
Mailing Address - Fax:
Practice Address - Street 1:3900 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4551
Practice Address - Country:US
Practice Address - Phone:215-823-5850
Practice Address - Fax:215-823-5969
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMDO396262084N0400X
PAMD0396262084N0600X
PAMD039626L2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Not Answered2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine