Provider Demographics
NPI:1902982879
Name:KUMAR, SANJAYA (MD)
Entity Type:Individual
Prefix:
First Name:SANJAYA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3588
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-1210
Practice Address - Street 1:115 WATER STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3011
Practice Address - Country:US
Practice Address - Phone:508-482-5411
Practice Address - Fax:508-482-5417
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2011-10-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA70712208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3125581Medicaid
MAQX1763Medicare PIN
MA3125581Medicaid