Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | MD064380L | PA |
NPI | 1124065495 |
---|---|
Provider Name | Sridhar Sampath Kumar |
First Address | Scranton, PA 18510-1624 |
Second Address | Scranton, PA 18510-1624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H26768 | (02) |