Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | NC |
NPI | 1508915216 |
---|---|
Provider Name | Dr. Sanjay Kumar |
First Address | New Bern, NC 28561-3727 |
Second Address | New Bern, NC 28562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136PJ | BCBS (01) | NC |
89136PJ | (05) | NC |
H72533 | (02) |