Provider Demographics
NPI:1982968582
Name:KUMAR, GOUTHAM (MBBS, MS)
Entity type:Individual
Prefix:
First Name:GOUTHAM
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MBBS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7070 FORWARD AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2549
Mailing Address - Country:US
Mailing Address - Phone:412-867-1129
Mailing Address - Fax:
Practice Address - Street 1:7070 FORWARD AVE APT 401
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2549
Practice Address - Country:US
Practice Address - Phone:412-867-1129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT202886204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery