Provider Demographics
NPI:1316233208
Name:GNANAKUMAR, VITHYA (MD)
Entity type:Individual
Prefix:DR
First Name:VITHYA
Middle Name:
Last Name:GNANAKUMAR
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 1:801 COMMISSIONERS ROAD EAST
Mailing Address - Street 2:PARKWOOD HOSPITAL, 4TH FLOOR HOBBINS BUILDING
Mailing Address - City:LONDON
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N6C5J1
Mailing Address - Country:CA
Mailing Address - Phone:519-685-8500
Mailing Address - Fax:
Practice Address - Street 1:801 COMMISSIONERS ROAD EAST
Practice Address - Street 2:PARKWOOD HOSPITAL, 4TH FLOOR HOBBINS BUILDING
Practice Address - City:LONDON
Practice Address - State:ONTARIO
Practice Address - Zip Code:N6C5J1
Practice Address - Country:CA
Practice Address - Phone:519-685-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097262208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation