Provider Demographics
NPI:1104902154
Name:KUMAR, AMRENDRA (MD)
Entity type:Individual
Prefix:MR
First Name:AMRENDRA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 HWY 9 BYPASS
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720
Mailing Address - Country:US
Mailing Address - Phone:803-285-2225
Mailing Address - Fax:
Practice Address - Street 1:1130 HWY 9 BYPASS W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720
Practice Address - Country:US
Practice Address - Phone:803-285-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCBK9868831OtherCONTROLLED SUBSTANCE
SC22N33N45OtherSC SUBSTANCE CONTROLLED
SC29114OtherSC MEDICAL LICENSE