Provider Demographics
NPI:1669034591
Name:CHERUKUMILLI, SUMANTH (MD)
Entity type:Individual
Prefix:DR
First Name:SUMANTH
Middle Name:
Last Name:CHERUKUMILLI
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 1:2411 W BELVEDERE AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5231
Mailing Address - Country:US
Mailing Address - Phone:410-601-9627
Mailing Address - Fax:
Practice Address - Street 1:2411 W BELVEDERE AVE STE 402
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5231
Practice Address - Country:US
Practice Address - Phone:410-601-9627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00959612080P0208X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program