Provider Demographics
NPI:1801835129
Name:KUMAR, MYSORE ANIL (MD)
Entity type:Individual
Prefix:
First Name:MYSORE
Middle Name:ANIL
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:SUITE 11511
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1321
Mailing Address - Country:US
Mailing Address - Phone:215-255-7822
Mailing Address - Fax:215-255-7825
Practice Address - Street 1:219 N BROAD ST
Practice Address - Street 2:8TH FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1519
Practice Address - Country:US
Practice Address - Phone:215-762-3900
Practice Address - Fax:215-762-3846
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD047277L208600000X, 204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001244154Medicaid
PAE98142Medicare UPIN