Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 11875 | WV |
NPI | 1164536264 |
---|---|
Provider Name | Chandra Mohan Kumar |
First Address | Charleston, WV 25314-1160 |
Second Address | Charleston, WV 25314-1160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 26/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0112177000 | (05) | WV |
D49302 | (02) |