Provider Demographics
NPI:1861139008
Name:KUMAR, SHRUTI ADIDAM (MBBS)
Entity type:Individual
Prefix:
First Name:SHRUTI ADIDAM
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OUTPATIENT CLINIC AT THE HOSPITAL OF CENTRAL CONNECTICU
Mailing Address - Street 2:100 GRAND STREET
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06050
Mailing Address - Country:US
Mailing Address - Phone:860-224-5261
Mailing Address - Fax:860-224-5957
Practice Address - Street 1:OUTPATIENT CLINIC AT THE HOSPITAL OF CENTRAL CONNECTICU
Practice Address - Street 2:100 GRAND STREET
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06050
Practice Address - Country:US
Practice Address - Phone:860-224-5261
Practice Address - Fax:860-224-5957
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program