Individual
MR. SANJEEV KUMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7601 FAIRBROOK RD, WINDSOR MILL, MD 21244-1652
(734) 474-3708
Mailing address
7601 FAIRBROOK RD, WINDSOR MILL, MD 21244-1652
(734) 474-3708
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
5601004613
MI
363AM0700X
Medical Physician Assistant
Primary
C0005442
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601004613
MI PHYSICIAN ASSISTANT PERMANENT ID NUMBER
MI
01
—
C0005442
MARYLAND STATE LICENSE
MD
Enumeration date
05/10/2008
Last updated
06/29/2015
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