Basic Information
| Provider Information | |||||||||
| NPI: | 1295759819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHLUWALIA | ||||||||
| FirstName: | KUMKUM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 LINDENWOOD DRIVE | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | MALVERN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155902897 | ||||||||
| FaxNumber: | 2155900325 | ||||||||
| Practice Location | |||||||||
| Address1: | 196 W SPROUL RD | ||||||||
| Address2: | HEALTHPLEX SUITE 205 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106040888 | ||||||||
| FaxNumber: | 6106040880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD-062578-L | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 001656961 | 05 | PA | MEDICAID |