Provider Demographics
NPI:1912347980
Name:MISRA, ABHINAV KUMAR (MBBS)
Entity Type:Individual
Prefix:
First Name:ABHINAV
Middle Name:KUMAR
Last Name:MISRA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 ELM STREET
Mailing Address - Street 2:DEPT OF CREDENTIALING
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-3017
Mailing Address - Country:US
Mailing Address - Phone:401-443-4992
Mailing Address - Fax:202-877-6292
Practice Address - Street 1:375 WAMPANOAG TRAIL
Practice Address - Street 2:PULMONARY & SLEEP MEDICINE
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915
Practice Address - Country:US
Practice Address - Phone:401-649-4070
Practice Address - Fax:401-649-4071
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMTL001692207R00000X
RIMD17190207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine