Provider Demographics
NPI:1114085792
Name:KUMAR, SANTOSH (MD)
Entity type:Individual
Prefix:
First Name:SANTOSH
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 1:3223 COLBY AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4306
Mailing Address - Country:US
Mailing Address - Phone:425-258-6446
Mailing Address - Fax:425-258-9696
Practice Address - Street 1:3223 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4306
Practice Address - Country:US
Practice Address - Phone:425-258-6446
Practice Address - Fax:425-258-9696
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014233208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1422609Medicaid
WA0017597OtherDEPT OF L & I
WA0017597OtherDEPT OF L & I
WA1422609Medicaid