Provider Demographics
NPI:1811949407
Name:TRIPATHY, KUMUD S (MD)
Entity type:Individual
Prefix:DR
First Name:KUMUD
Middle Name:S
Last Name:TRIPATHY
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 1:2215 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
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9046207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125738100OtherFIRST CARE
TX110135938OtherMEDICARE RAILROAD
TX100005101Medicaid
TXC22780Medicare UPIN
TX82600BMedicare ID - Type Unspecified