Provider Demographics
NPI:1194787614
Name:KUMAR, DHARMENDRA (MD,)
Entity type:Individual
Prefix:
First Name:DHARMENDRA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,
Mailing Address - Street 1:PO BOX 17383
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1383
Mailing Address - Country:US
Mailing Address - Phone:410-328-5656
Mailing Address - Fax:410-328-2115
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:410-328-5656
Practice Address - Fax:410-328-2115
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD362192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE14743Medicare UPIN
MDP00078445Medicare PIN
MD865LH443Medicare PIN
MDH380H390Medicare PIN