Provider Demographics
NPI:1104851377
Name:HENDRIX, KUMUDHINI (MD)
Entity type:Individual
Prefix:DR
First Name:KUMUDHINI
Middle Name:
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 418283
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8283
Mailing Address - Country:US
Mailing Address - Phone:703-558-1544
Mailing Address - Fax:
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-6331
Practice Address - Fax:410-328-1674
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046205171100000X, 207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No171100000XOther Service ProvidersAcupuncturist
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00773615OtherRAILROAD MEDICARE
MD218911900Medicaid
MDF92767Medicare UPIN
DC015734YT2Medicare PIN
DCP00773615OtherRAILROAD MEDICARE
MD144150ZAV6Medicare PIN
MDML13Medicare PIN