Provider Demographics
NPI:1053362178
Name:KUMAR, SANJEEV (MD)
Entity type:Individual
Prefix:
First Name:SANJEEV
Middle Name:
Last Name:KUMAR
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 1:819 N FANT ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5717
Mailing Address - Country:US
Mailing Address - Phone:864-261-1800
Mailing Address - Fax:864-261-1856
Practice Address - Street 1:819 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5717
Practice Address - Country:US
Practice Address - Phone:864-261-1800
Practice Address - Fax:864-261-1856
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28036208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC280369Medicaid
SCP00246234OtherRR MEDICARE
SCP00964173OtherRR MEDICARE
SC280369Medicaid
1153Medicare PIN
SCP00246234OtherRR MEDICARE
6347Medicare PIN